Transapical transcatheter aortic valve replacement with a novel transcatheter aortic valve replacement system in high-risk patients with severe aortic valve diseases.

Abstract

OBJECTIVES:

The clinical experience of a novel transapical transcatheter aortic valve replacement system, the J-Valve (JC Medical Inc, Burlingame, Calif), in high-risk patients with severe aortic valve diseases is limited.

METHODS:

A total of 107 high-risk patients (mean age, 74.4 ± 5.2 years) underwent transcatheter aortic valve replacement with the J-Valve from March 2014 to July 2015, which included 63 patients with aortic stenoses and 44 patients with aortic regurgitation. Echocardiography and contrast-enhanced computed tomography were used to evaluate patients' baseline characteristics and their follow-up conditions.

RESULTS:

The J-Valve was successfully implanted in 102 patients (95.3%). Five patients (4.7%) underwent conversion to open surgery. The overall mortality was 4.7% (n = 5) at both 30 days and 6 months, whereas subgroup mortality was 6.3% (n = 4) in the aortic stenosis group and 2.3% (n = 1) in the aortic regurgitation group. Permanent pacemakers were implanted in 5 patients (4.7%). In the aortic stenosis group, paravalvular regurgitation was observed as none or trace in 54.2% of patients (n = 32), mild in 42.4% of patients (n = 25), and moderate in 3.4% of patients (n = 2) postprocedure. The mean aortic gradient decreased from 56.7 ± 15.2 mm Hg to 14.4 ± 7.8 mm Hg (P < .01). The peak aortic valve velocity declined from 4.76 ± 0.6 m/s to 2.45 ± 0.57 m/s (P < .01). In the patients with aortic regurgitation, paravalvular regurgitation was none or trace in 74.4% (n = 32), mild in 23.3% (n = 10), and 2.3% (n = 1) after the procedure. Mean aortic gradient was 7.1 ± 2.9 mm Hg.

CONCLUSIONS:

Transcatheter aortic valve replacement by the J-Valve is an adequate clinical option to treat high-risk patients with severe aortic stenosis or aortic regurgitation.

• Authors: Liming Zhu, Yingqiang Guo, Wei Wang, Huan Liu, Ye Yang, Lai Wei, Chunsheng Wang
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 155 Issue 2 Pg. 588-597 (02 2018) ISSN: 1097-685X [Electronic] United States
• PMID: 28992963 (Publication Type: Journal Article, Video-Audio Media)
• Copyright: Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aortic Valve (diagnostic imaging, physiopathology, surgery)
• Aortic Valve Insufficiency (diagnostic imaging, mortality, physiopathology, surgery)
• Aortic Valve Stenosis (diagnostic imaging, mortality, physiopathology, surgery)
• Conversion to Open Surgery
• Echocardiography, Doppler, Color
• Echocardiography, Transesophageal
• Female
• Heart Valve Prosthesis
• Humans
• Male
• Postoperative Complications (mortality, surgery)
• Prosthesis Design
• Recovery of Function
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Time Factors
• Tomography, X-Ray Computed
• Transcatheter Aortic Valve Replacement (adverse effects, instrumentation, mortality)
• Treatment Outcome