Application of echocardiography in early efficacy evaluation after transapical transcatheter aortic valve replacement via transapical approach

Chaolong JIN, Xuegong SHI, Chengxin ZHANG, Youfeng LIANG, Jie XIAO, Zhe SHENG, Dingxin ZHANG

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J Jilin Univ Med Ed ›› 2025, Vol. 51 ›› Issue (1) : 228-237. DOI: 10.13481/j.1671-587X.20250128
Imageology

Application of echocardiography in early efficacy evaluation after transapical transcatheter aortic valve replacement via transapical approach

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Abstract

Objective To discuss the clinical application value of echocardiography in evaluating the early outcomes of transcatheter aortic valve replacement (TAVR) via the transapical approach, and to clarify the role of echocardiography in assessing the efficacy of the surgery. Methods The clinical data of 85 patients who received J-Valve prosthetic valves via the transapical TAVR were retrospectively analyzed. The patients were divided into AS group (simple aortic stenosis, n=20), AR group (simple aortic regurgitation, n=37), and AS&AR group (aortic stenosis with regurgitation, n=28). Echocardiographic examination was performed on all the patients before operation, 1 week after operation, 3 months after operation, and 6 months after operation. The parameters including left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), aortic valve peak flow velocity (AV Vmax), aortic valve mean transvalvular pressure gradient (AV PGmean), and paravalvular leak (PVL) width were measured to evaluate the cardiac function and the function of the prosthetic valve; the occurrence of postoperative complications of the patients in various groups was also analyzed. Results J-Valve prosthetic valves were successfully implanted in all 85 patients. There were no significant differences in age, gender, New York Heart Association (NYHA) heart function classification, history of hypertension, history of diabetes, history of hyperlipidemia, and history of coronary artery disease among various groups befor operation(P>0.05), ensuring comparability. Compared with before operation, 1 week after operation, the AV Vmax and AV PGmean of the patients in AS group and AS&AR group were decreased (P<0.05); there were no significant differences in various parameters of the patients in AR group (P>0.05). Compared with before operation, 3 months after operation, the LVEF and LVFS of the patients in AS group were increased (P<0.05), while the AV Vmax and AV PGmean were decreased (P<0.05); the LVEDV and LVESV of the patients in AR group were decreased (P<0.05), while the LVEF and LVFS were increased (P<0.05); the LVEDV, LVESV, AV Vmax, and AV PGmean of the patients in AS&AR group were decreased (P<0.05), while the LVEF and LVFS were increased (P<0.05). Compared with before operation, LVEDV, LVESV, IVST, and LVPWT of the patients in all three groups 6 months after operation were decreased (P<0.05), while LVEF and LVFS were increased (P<0.05); the AV Vmax and AV PGmean of the patients in AS group and AS&AR group were decreased (P<0.05); the AV PGmean of the patients in AR group was decreased (P<0.05). The postoperative complications included 3 cases of permanent pacemaker implantation (2 cases in AS group, 1 case in AR group), 1 case of stroke (in AS group), and 13 cases of PVL (4 cases in AS group, 5 cases in AR group, 4 cases in AS&AR group). No deaths occurred during follow-up. Conclusion Echocardiography can accurately and quantitatively evaluate early changes in cardiac function and the functional state of prosthetic valves after transapical TAVR, providing objective evidence for evaluating surgical outcomes and postoperative complications.

Key words

Echocardiography / Transcatheter aortic valve replacement / Transapical approach / Aortic stenosis / Aortic regurgitation

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Chaolong JIN , Xuegong SHI , Chengxin ZHANG , et al . Application of echocardiography in early efficacy evaluation after transapical transcatheter aortic valve replacement via transapical approach. Journal of Jilin University(Medicine Edition). 2025, 51(1): 228-237 https://doi.org/10.13481/j.1671-587X.20250128

References

1
李 喆, 郭 帅, 叶蕴青, 等. 中国中重度主动脉瓣疾病患者的临床特点及预后: 来自China-VHD研究的分析[J]. 中国循环杂志202237(4): 322-328.
2
张 泽, 蒋 伟, 李思聪, 等. 全胸腔镜微创心脏手术临床疗效分析[J]. 中国临床新医学202316(4): 375-378.
3
KHEIRI B OSMAN M BAKHIT A, et al. Meta-analysis of transcatheter aortic valve replacement in low-risk patients[J]. Am J Med2020133(2): e38-e41.
4
罗一纯, 刘路路, 石 峻, 等. 应用J-Valve瓣膜经导管主动脉瓣置换术治疗高危单纯主动脉瓣反流多中心研究早期临床结果[J]. 中国胸心血管外科临床杂志201926(8): 737-743.
5
时应路, 张成鑫, 郭志祥, 等. 经心尖途径经导管主动脉瓣置换术治疗主动脉瓣关闭不全的早期疗效分析[J]. 中国胸心血管外科临床杂志202330(8): 1116-1120.
6
张 航, 安景辉, 刘 苏, 等. 经心尖经导管主动脉瓣置换术治疗主动脉瓣膜病变的临床研究[J]. 心脑血管病防治202323(11): 47-48, 52.
7
SHI J WEI L CHEN Y, et al. Transcatheter aortic valve implantation with J-valve: 2-year outcomes from a multicenter study[J]. Ann Thorac Surg2021111(5): 1530-1536.
8
孙艳丹, 李昱茜, 白 炜, 等. 三维经食管超声心动图在心尖入路经导管主动脉瓣置换术中的应用价值[J]. 临床超声医学杂志202325(1): 58-61.
9
BENFARI G SETTI M NISTRI S, et al. Relevance of functional mitral regurgitation in aortic valve stenosis[J]. Am J Cardiol2020136: 115-121.
10
ILIUTA L ANDRONESI A G DIACONU C C, et al. Diastolic versus systolic left ventricular dysfunction as independent predictors for unfavorable postoperative evolution in patients with aortic regurgitation undergoing aortic valve replacement[J]. Medicina (Kaunas)202258(11): 1676.
11
宋 羿, 张大发. 主动脉瓣置换治疗主动脉瓣膜疾病的临床效果[J]. 右江民族医学院学报202042(1): 61-63.
12
PANÇ C YILMAZ E GÜRBAK İ, et al. Effect of prognostic nutritional index on short-term survival after transcatheter aortic valve implantation[J]. Turk Kardiyol Dern Ars202048(6): 585-593.
13
金朝龙, 史学功, 林先和, 等. 实时三维经食道超声心动图在室间隔缺损微创封堵术中的应用[J]. 安徽医科大学学报201853(5): 812-815.
14
BLEAKLEY C MONAGHAN M. 3D transesophageal echocardiography in TAVR[J]. Echocardiography202037(10): 1654-1664.
15
MEHTA A SALE S CAPDEVILLE M. The deployment of valve academic research consortium 3 (VARC-3): new endpoints, broader definitions, and plenty of unanswered questions[J]. J Cardiothorac Vasc Anesth202135(12): 3463-3466.
16
冯晔子, 张申伟, 马倩倩, 等. 主动脉瓣重度狭窄经导管主动脉瓣置换术后患者围术期效果观察[J]. 心肺血管病杂志201938(11): 1146-1149.
17
周广为, 李 宁, 费 翔, 等. 二维超声心动图评价经导管主动脉瓣置入术后早期左心形态及收缩功能[J]. 第二军医大学学报202041(8): 864-870.
18
LIU L PENG Y SHI J,et al. Initial experience with repositionable J-Valve for severe aortic regurgitation: a single-center experience[J].J Cardiovasc Surg(Torino)202263(4):521-528.
19
SAMMOUR Y KRISHNASWAMY A KUMAR A, et al. Incidence, predictors, and implications of permanent pacemaker requirement after transcatheter aortic valve replacement[J]. JACC Cardiovasc Interv202114(2): 115-134.
20
AUFFRET V, PURI, URENA M, et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives[J]. Circulation2017136(11): 1049-1069.
21
SCHOECHLIN S HEIN M BRENNEMANN T, et al. 5-year outcomesafter transcatheter aortic valve implantation: focus on paravalvular leakage assessed by echocardiography and hemodynamic parameters[J]. Cathet Cardio Intervent202299(5): 1582-1589.
22
LAAKSO T LAINE M MORIYAMA N, et al. Impact of paravalvular regurgitation on the mid-term outcome after transcatheter and surgical aortic valve replacement[J]. Eur J Cardiothorac Surg202058(6):1145-1152.
23
XUE Y ZHOU Q LI S, et al. Transapical transcatheter valve replacement using J-valve for aortic valve diseases[J]. Ann Thorac Surg2021112(4):1243-1249.
24
中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术中国专家共识(2020更新版)[J]. 中国介入心脏病学杂志202028(6): 301-309.
25
SCHEWEL D FRERKER C SCHEWEL J, et al. Clinical impact of paravalvular leaks on biomarkers and survival after transcatheter aortic valve implantation[J]. Catheter Cardiovasc Interv201585(3): 502-514.

金朝龙参与论文的撰写,史学功参与论文的设计,张成鑫参与论文病例的收集,梁有峰参与论文讨论部分的分析, 肖洁参与论文数据的统计学分析,盛哲参与论文参考文献的检索,张定欣参与论文病例资料的收集。

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