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Li Y, Lei R, Zhou J, Wu K, Shen J, Zhu Z, Wang J, Zhang H. Innovative use of a self-expanding valve for valve-in-valve transcatheter mitral valve replacement: experience from a four-year single-center study. Front Cardiovasc Med 2023; 10:1137663. [PMID: 37378395 PMCID: PMC10292798 DOI: 10.3389/fcvm.2023.1137663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Background Valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) is a minimally invasive option for patients with bioprosthetic mitral valve failure. Since January 2019, our center has been using a new innovative option, J-Valve, to treat patients with bioprosthetic mitral valve failure who were at high risk for open heart surgery. The aim of this study is to explore the effectiveness and safety of J-Valve and report the results from the four-year follow-up period of the innovative application of the transcatheter valve. Methods Patients who underwent the ViV-TMVR procedure between January 2019 and September 2022 in our center were included in the study. J-Valve™ system (JC Medical Inc., Suzhou, China) with three U-shape grippers was used for ViV-TMVR via transapical approach. Data on survival, complications, transthoracic echocardiographic results, New York Heart Association functional class in heart failure, and patient-reported health-related quality of life according to the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) were collected during the four-year follow up. Results Thirty-three patients (mean age 70.1 ± 1.1 years, 13 men) were included and received ViV-TMVR. The surgery success rate was 97%: only one patient was converted to open-heart surgery due to intraoperative valve embolization to the left ventricle. During the first 30 days all-cause mortality was 0%, risk of stroke 2.5% and risk of mild paravalvular leak 15.2%; mitral valve hemodynamics improved (179.7 ± 8.9 at 30 days vs. 269 ± 49 cm/s at baseline, p < 0.0001). Median time from operation to discharge was six days, and there were no readmissions within 30 days from operation. The median and maximum follow-up durations were 28 and 47 months, respectively; during the entire follow-up, all-cause mortality was 6.1%, and the risk of cerebral infarction 6.1%. Cox regression analysis did not identify any variables significantly associated with survival. The New York Heart Association functional class and the KCCQ-12 score improved significantly compared with their preoperative values. Conclusion The use of J-Valve for ViV-TMVR is safe and effective with a high success rate, low mortality and very few associated complications, representing an alternative surgical strategy for the elderly, high-risk patients with bioprosthetic mitral valve failure.
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Affiliation(s)
- Yuehuan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruobing Lei
- Chevidence Lab of Child & Adolescent Health, Department of Pediatric Research Institute, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jiawei Zhou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kaisheng Wu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinglun Shen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhihui Zhu
- Department of Medicine IV, LMU University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Shimizu A, Takanashi S, Takamisawa I, Shimokawa T, Takayama M, Isobe M. Transapical septal myectomy for hypertrophic cardiomyopathy, an experience from Japan. Asian Cardiovasc Thorac Ann 2022; 30:108-114. [PMID: 35291875 DOI: 10.1177/02184923221081194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While there are a variety of surgical options for hypertrophic cardiomyopathy, there are small number of reports of transapical septal myectomy. Furthermore, the characteristics and incidence of anomalous structures in the left ventricle in hypertrophic cardiomyopathy patients which can be identified with imaging studies are not clear. METHODS We studied hypertrophic cardiomyopathy patients who underwent transapical septal myectomy from July 2013 to December 2019. We evaluated the frequency and characteristics of anomalous structures in the left ventricle which had been identified by preoperative examinations and studied their postoperative results. RESULTS A total of 59 patients was included. The median age was 40 years. Sixteen patients (27.4%) were in New York Heart Association Functional Classification III or IV. The median peak intraventricular gradient at rest was 65 mmHg. By preoperative imaging studies, anomalous structures were detected in 56 cases (94.9%), of which 88% were successfully resected with myectomy. There were two perioperative deaths, while one late death caused by acute myocardial infarction occurred. The estimated 5-year survival rate was 95%. The intraventricular gradient had significantly decreased at the time of discharge, and no reoperation for recurrent obstruction was conducted. The left ventricular ejection fraction had significantly decreased after the operation, was however within the normal range. Left atrium volume index and tricuspid regurgitant velocity significantly improved. CONCLUSIONS Patients receiving transapical septal myectomy restored good hemodynamics from early postoperative period and showed improved subjective symptoms and good mid-term results. With multimodal imaging studies, we could accurately identify anomalous structures in hypertrophic cardiomyopathy patients and reliably treat them by transapical septal myectomy.
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Affiliation(s)
- Atsushi Shimizu
- Department of Cardiovascular Surgery, 26383Sakakibara Heart Institute, Japan.,Department of Cardiovascular Surgery, 38455Saitama Sekishinkai Hospital, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, 26383Sakakibara Heart Institute, Japan.,Hypertrophic Cardiomyopathy Center, 26383Sakakibara Heart Institute, Japan.,Department of Cardiovascular Surgery, 50211Kawasaki Saiwai Hospital, Japan
| | - Itaru Takamisawa
- Hypertrophic Cardiomyopathy Center, 26383Sakakibara Heart Institute, Japan.,Department of Cardiology, 26383Sakakibara Heart Institute, Japan
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, 26383Sakakibara Heart Institute, Japan.,Hypertrophic Cardiomyopathy Center, 26383Sakakibara Heart Institute, Japan
| | - Morimasa Takayama
- Hypertrophic Cardiomyopathy Center, 26383Sakakibara Heart Institute, Japan.,Department of Cardiology, 26383Sakakibara Heart Institute, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, 26383Sakakibara Heart Institute, Japan
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Agostinelli A, Gallingani A, Maestri F, Grossi S, Gripshi F, De Donno L, Nicolini F. Left Ventricular Apex: A "Minimally Invasive Motorway" for Safe Cardiovascular Procedures. J Clin Med 2021; 10:3857. [PMID: 34501308 DOI: 10.3390/jcm10173857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
Since the advent of TAVR (transcatheter aortic valve replacement), the transapical surgical approach has been affirmed as a safe and effective alternative access for patients with unsuitable peripheral arteries. With the improvement of devices for transfemoral approach and the development of other alternative accesses, the number of transapical procedures has decreased significantly worldwide. The left ventricular apex, however, has proved to be a safe and valid alternative access for various other structural heart procedures such as mitral valve repair, mitral valve-in-valve or valve-in-ring replacement, transcatheter mitral valve replacement (TMVR), transcatheter mitral paravalvular leak repair, and thoracic aorta endovascular repair (TEVAR). We review the literature and our experience of various hybrid transcatheter structural heart procedures using the transapical surgical approach and discuss pros and cons.
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Bautista-Rodriguez C, Michielon G, Di Salvo G, Aw TC, Butera G, Kempny A, Fraisse A. Transapical Mitral Melody Valve-in-Valve Implantation in a Child: An Interesting Alternative for Failing Melody Valve. JACC Cardiovasc Interv 2019; 12:e137-e138. [PMID: 31377271 DOI: 10.1016/j.jcin.2019.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/23/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Carles Bautista-Rodriguez
- Paediatric Cardiology and Cardiac Surgery Services, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Guido Michielon
- Paediatric Cardiology and Cardiac Surgery Services, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Giovanni Di Salvo
- Paediatric Cardiology and Cardiac Surgery Services, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tuan-Chen Aw
- Paediatric Cardiology and Cardiac Surgery Services, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Gianfranco Butera
- Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Aleksander Kempny
- Paediatric Cardiology and Cardiac Surgery Services, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Alain Fraisse
- Paediatric Cardiology and Cardiac Surgery Services, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
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Abdi S, Nazeri I, Mandegar MH, Mortazavi SH, Geraiely B. Mitral valve-in-valve replacement supported by a transapically snared guidewire via septostomy. J Card Surg 2019; 34:732-734. [PMID: 31269279 DOI: 10.1111/jocs.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/16/2019] [Indexed: 11/30/2022]
Abstract
We describe a 72-year-old woman, a known case of rheumatic heart disease with a history of mitral and aortic valve replacement 8 years previously, who underwent mitral valve-in-valve replacement supported by a transapically snared guidewire through septostomy.
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Affiliation(s)
- Seifollah Abdi
- Department of Interventional Cardiology, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Iraj Nazeri
- Department of Cardiology, Day General Hospital, Tehran, Iran
| | - Mohammad Hossein Mandegar
- Department of Cardiac Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Babak Geraiely
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Abdelaziz HK, Wiper A, More RS, Bittar MN, Roberts DH. Successful Transcatheter Aortic Valve Replacement Using Balloon-Expandable Valve for Pure Native Aortic Valve Regurgitation in the Presence of Ascending Aortic Dissection. J Invasive Cardiol 2018; 30:E62-E63. [PMID: 29958182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The use of balloon-expandable prosthesis in the treatment of native aortic valve regurgitation in the presence of ascending aortic dissection is described.
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Affiliation(s)
- Hesham K Abdelaziz
- Blackpool Teaching Hospital, Whinney Heys Road, FY3 8NR, Blackpool, United Kingdom.
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Hayashida K, Yamamoto M. Transapical Approach: Learn From the Past, Move Toward the Future. JACC Cardiovasc Interv 2017; 10:2423-2425. [PMID: 29217005 DOI: 10.1016/j.jcin.2017.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
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Wei J, Yin WH, Lee YT, Hsiung MC, Tsai SK, Chuang YC, Ou CH, Chou YP. Intraoperative three-dimensional transesophageal echocardiography for assessing the defect geometries of mitral prosthetic paravalvular leak during transcatheter closure. J Chin Med Assoc 2015; 78:158-63. [PMID: 25467793 DOI: 10.1016/j.jcma.2014.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 08/11/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Paravalvular leaks (PVLs) are a common complication of prosthetic valve replacement. Use of the transcatheter intervention technique is a suitable alternative in high-risk patients who may not tolerate repeat surgery. Common reasons for failure of this demanding intervention include poor imaging quality and unsuitable anatomy. The purpose of this study was to assess the usefulness and the incremental value of real-time three-dimensional (RT 3D) transesophageal echocardiography (TEE) over two-dimensional (2D) TEE findings in the evaluation of the geometry and track of mitral PVLs during transcatheter closure. METHODS Five patients with six mitral PVLs at high risk for repeat surgery underwent transcatheter leak closure. Intraoperative RT 3DTEE was used to assess the location, shape, number, and size of the defects. Transapical approaches were used in all cases with fluoroscopic and RT 3D TEE guidance of the wire and catheter, device positioning, and assessment of residual leak after the procedure. RESULTS In all of the cases, defects with irregular crescent shapes and distorted tracks were clearly delineated by RT 3D TEE. This was compared to those results obtained through 2D TEE, which was unable to characterize the defects. Three cases showed small leaks, which were completely occluded with a patent ductus arteriosus (PDA) device in two cases, and a muscular ventricular septal defect (mVSD) occluder combined with coil devices in one case. One case involved a large leak and early device embolization of the muscular VSD occluder, which was removed surgically, and demonstrated a crescent-shaped defect. One patient had two releaks 2 months subsequent to the procedure due to two new extended leaks at the tails of the crescent-shaped defect. CONCLUSION RT 3D TEE can clearly delineate the geometries of defects in their entirety, including shape, size, and location of the defect and track canal. It would also appear that RT 3D TEE is superior to 2D TEE in the process of guiding the wire through the difficult canal anatomy, facilitating the overall procedure. The small mitral PVLs can be completely occluded, but subsequent complications occurred with large defect closures because of embolization or releak. Therefore, transcatheter closure of PVLs seems to be an attractive alternative for these patients, but newer occluder designs that better conform to leak geometry will be required to improve outcomes.
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Affiliation(s)
- Jeng Wei
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Wei-Hsian Yin
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Yung-Tsai Lee
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Ming C Hsiung
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Shen-Kou Tsai
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC.
| | - Yi Cheng Chuang
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Ching-Huei Ou
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Yi-Pen Chou
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
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Noble S. Transapical aortic valve implantation: a reasonable therapeutic option, but not the only alternative to transfemoral approach. J Thorac Dis 2013; 5:360-1. [PMID: 23825775 DOI: 10.3978/j.issn.2072-1439.2013.06.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/10/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Stephane Noble
- Department of Medical Specialties, Interventional Cardiology Unit, University Hospital of Geneva, Switzerland
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