Department of Cardiac Surgery, Zhongshan Hospital, Fudan University.
Shanghai Engineering Research Center of Heart Valve.
Int Heart J. 2022;63(1):30-35. doi: 10.1536/ihj.21-360.
Patients with aortic stenosis and low left ventricular ejection fraction (LVEF) would benefit from transcatheter aortic valve replacement. However, the safety and efficacy of transcatheter aortic valve replacement in patients with aortic regurgitation and left ventricular dysfunction remains unknown.We defined LVEF < 50% as left ventricular dysfunction. A total of 27 symptomatic patients with aortic regurgitation and ejection fraction < 50% underwent transcatheter aortic valve replacement using the J-Valve™ system (JieCheng Medical Technology Co, Ltd, Suzhou, China) in Zhongshan Hospital, Fudan University, from May 2014 to June 2019. Procedural and postoperative clinical outcomes were analyzed according to Valve Academic Research Consortium-2 (VARC-2) criteria.All patients (eight females; 70.6 ± 7.1 years) were considered to be at least intermediate surgical risk and/or severe comorbidity precluding for surgical aortic valve replacement (logistic European System for Cardiac Operative Risk Evaluation, 16.8 ± 9.5%, range 4.6% to 37.9%) by a multidisciplinary heart team. Transapical implantations were successful in 26 (96.3%) patients. All-cause mortality was 3.7% in the latest follow-up (25-590 days, median 369 days). Significant improvements in LVEF, left ventricular end-diastolic, and systolic dimensions were observed after procedure (from 40.3 ± 6.7% to 50.8 ± 10.5%, P < 0.001; from 65.1 ± 8.9 mm to 56.0 ± 9.6 mm, P = 0.002; from 52.2 ± 9.8 mm to 35.9 ± 13.4 mm, P < 0.001, respectively). No patient had aortic stenosis and paravalvular leak more than moderate and heart function improvement was obtained in the majority of patients at 1-year follow-up.Transcatheter aortic valve replacement using the J-Valve™ system is a reasonable alternative for patients with aortic regurgitation and left ventricular dysfunction regarding promising short-term outcomes.
患有主动脉瓣狭窄和左心室射血分数（LVEF）降低的患者将从经导管主动脉瓣置换术中受益。然而，经导管主动脉瓣置换术在主动脉瓣反流和左心室功能障碍患者中的安全性和疗效仍不清楚。我们将 LVEF < 50%定义为左心室功能障碍。2014 年 5 月至 2019 年 6 月，复旦大学中山医院使用 J-Valve™系统（JieCheng Medical Technology Co，Ltd，苏州，中国）对 27 例有症状的主动脉瓣反流和射血分数<50%的患者进行了经导管主动脉瓣置换术。根据 Valve Academic Research Consortium-2（VARC-2）标准分析了手术过程和术后的临床结果。所有患者（8 名女性；70.6 ± 7.1 岁）均被认为至少存在中危手术风险和/或严重合并症，不适合外科主动脉瓣置换术（多学科心脏团队的 logistic European System for Cardiac Operative Risk Evaluation，16.8 ± 9.5%，范围 4.6%至 37.9%）。26 例（96.3%）患者经心尖植入成功。最新随访时（25-590 天，中位数 369 天）的全因死亡率为 3.7%。手术后，LVEF、左心室舒张末期和收缩末期内径均显著改善（从 40.3 ± 6.7%增加至 50.8 ± 10.5%，P < 0.001；从 65.1 ± 8.9mm 减少至 56.0 ± 9.6mm，P = 0.002；从 52.2 ± 9.8mm 减少至 35.9 ± 13.4mm，P < 0.001）。无患者发生主动脉瓣狭窄和瓣周漏超过中度，大多数患者在 1 年随访时获得了心功能改善。对于主动脉瓣反流和左心室功能障碍患者，使用 J-Valve™系统的经导管主动脉瓣置换术是一种合理的替代治疗方法，具有良好的短期疗效。
