Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Cardiovascular Surgery, West China Hospital, Chengdu, Sichuan, China.
J Thorac Cardiovasc Surg. 2018 Feb;155(2):588-597. doi: 10.1016/j.jtcvs.2017.09.015. Epub 2017 Sep 15.
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.
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.
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.
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.
新型经心尖经导管主动脉瓣置换系统 J-Valve（JC Medical Inc，加利福尼亚州伯林格姆）在患有严重主动脉瓣疾病的高危患者中的临床经验有限。
2014 年 3 月至 2015 年 7 月，共有 107 例高危患者（平均年龄 74.4±5.2 岁）接受了 J-Valve 经导管主动脉瓣置换术，其中 63 例为主动脉瓣狭窄患者，44 例为主动脉瓣反流患者。超声心动图和增强型计算机断层扫描用于评估患者的基线特征及其随访情况。
102 例（95.3%）患者成功植入 J-Valve。5 例（4.7%）患者转为开放性手术。30 天和 6 个月时的总死亡率均为 4.7%（n=5），亚组死亡率分别为主动脉瓣狭窄组 6.3%（n=4）和主动脉瓣反流组 2.3%（n=1）。5 例（4.7%）患者植入永久性起搏器。在主动脉瓣狭窄组，54.2%（n=32）的患者术后出现微量或无瓣周反流，42.4%（n=25）的患者出现轻度瓣周反流，3.4%（n=2）的患者出现中度瓣周反流。主动脉瓣跨瓣压差从 56.7±15.2mmHg 降至 14.4±7.8mmHg（P<.01）。主动脉瓣峰值速度从 4.76±0.6m/s 降至 2.45±0.57m/s（P<.01）。在主动脉瓣反流患者中，74.4%（n=32）、23.3%（n=10）和 2.3%（n=1）术后出现微量或无瓣周反流，轻度瓣周反流。主动脉瓣跨瓣压差为 7.1±2.9mmHg。
J-Valve 经导管主动脉瓣置换术是治疗高危严重主动脉瓣狭窄或反流患者的一种合适的临床选择。
