Lai Wei

Background: Transcatheter aortic valve replacement (TAVR) using the J-Valve system provides a solution for patients with aortic regurgitation (AR). However, it remains unclear whether its coaxiality performance is related to procedural complications. Aim: Our goal was to improve the efficacy and accuracy of TAVR in patients with AR by adjusting J-Valve coaxiality using three-dimensional printing (3DP). Methods: This multicenter, prospective study included 612 patients with AR who underwent transapical TAVR. Of these, 228 patients were assigned to the 3DP group, in which the insertion angle and implantation depth were pre-determined. The coaxiality index was calculated using the distances from the bottom of the bioprosthesis to the base of the three cusps. Results: Compared to the non-3DP group, the 3DP group demonstrated better coaxiality performance (coaxiality index: 3.4 ± 1.7 vs. 4.0 ± 2.1; coaxiality angle: 10.5 ± 3.7° vs. 12 ± 4.2°; both p<0.001). Post-operative coaxiality index showed a strong correlation with the coaxiality angle (correlation coefficients: 0.85 in the 3DP group and 0.88 in the non-3DP group). The procedural success rate was higher in the 3DP group (100% vs. 96.4%; p=0.008). Paravalvular leakage (PVL) occurred less frequently in the 3DP group (mild PVL: 3.51% vs. 18.2%; p<0.001; moderate PVL: 0% vs. 1.04%; p<0.001). Multivariable analysis identified the coaxiality index, coaxiality angle, and horizocardia as independent predictors of PVL. Conclusion: PVL incidence after TAVR can be reduced through pre-operative simulations that adjust coaxiality using 3DP. Relevance for patients: The high incidence of PVL in transapical TAVR with the J-Valve is associated with coaxiality after bioprosthesis implantation. This study suggests that adjusting coaxiality using pre-procedural 3DP simulations may effectively reduce PVL incidence and other procedural complications during transapical TAVR. In the future, randomized clinical trials will be needed to evaluate the efficacy and accuracy of pre-procedural 3DP simulations and the coaxiality index in treating patients with pure AR undergoing transapical TAVR.

Background: The impact of aortic arch (AA) morphology on the management of the procedural details and the clinical outcomes of the transfemoral artery (TF)-transcatheter aortic valve replacement (TAVR) has not been evaluated. The goal of this study was to evaluate the AA morphology of patients who had TF-TAVR using an artificial intelligence algorithm and then to evaluate its predictive value for clinical outcomes. Materials and methods: A total of 1480 consecutive patients undergoing TF-TAVR using a new-generation transcatheter heart valve at 12 institutes were included in this retrospective study. The AA measurements were evaluated by deep learning, and then the approach index (I_A) was determined. The machine learning algorithm was used to construct the predictive model and was validated externally. Results: The area under the curve of the I_A model using random forest and logistic regression was 0.675 [95% confidence interval (CI): 0.586–0.764] and 0.757 (95% CI: 0.665–0.849), respectively. The I_A model was validated externally, and consistent distinctions were obtained. After we used a generalized propensity score matching method for continuous exposure, the I_A was the strongest correlation factor for major procedural events (odds ratio: 3.87; 95% CI: 2.13–7.59, P < 0.001). When leaflet morphology or transcatheter heart valve type was an interactive item with I_A, neither of them was statistically significant in terms of clinical outcomes. Conclusion: I_A may be used to identify the impact of AA morphology on procedural and clinical outcomes in patients having TF-TAVR and to help to predict the procedural complications.

The authors report the mid-term outcomes following transcatheter edge-to-edge repair using the ValveClamp system from a multi-center database of patients with both atrial and ventricular secondary mitral regurgitation (MR_ and further evaluated the predictors of a residual MR of at least 2+. Original Contribution from Journal of Invasive Cardiology. edge-to-edge mitral valve repair Mitral regurgitation Mitral valve repair TEER

Purpose: Transcatheter aortic valve replacement (TAVR) induced coronary artery obstruction (CAO) is a rare but devastating complication. Current preventive strategies need additional procedures and may be associated with adverse events. This study aimed to evaluate the early safety and efficacy of stand-alone TAVR using the J-Valve (Jianshi JieCheng Medical Technology Co. Ltd, Shanghai, China) in patients at potential high risk for CAO. Patients and Methods: CAO was defined as coronary ostia obstruction requiring intervention. Patients at potential high risk for CAO were identified retrospectively from 673 consecutive patients who underwent TAVR from January 2015 to July 2021 at Zhongshan Hospital, Fudan University. Procedural results and early outcomes were evaluated according to Valve Academic Research Consortium-3 definitions. Results: A total of 20 consecutive patients (age 72 ± 9 years; 85% female;) were included. The Society of Thoracic Surgeons-Predicted Risk of Mortality was 5% (interquartile range, 4 to 10%). All patients (100%) had at least 2 classical risk factors for CAO by pre-procedural computed tomography analysis, and 90% patients had native aortic valve diseases. TAVR was successful in 95% of cases, with only 1 patient requiring second device implantation. Early safety at 30 days was achieved in all cases without death. All patients were free from CAO, stroke or emergency reintervention. Post-procedural mean aortic valve gradient was 7 (interquartile range, 4, 12) mmHg, and none/trace or mild aortic regurgitation was present in all patients. Conclusion: Stand-alone TAVR using the J-Valve may mitigate the risk of TAVR-induced CAO.

Background: The improvement rate and predictors of secondary mitral regurgitation in patients with aortic regurgitation undergoing transcatheter aortic valve replacement (TAVR) remain unclear. This study aimed to identify predictors of persistent moderate to severe secondary mitral regurgitation after TAVR in patients with aortic regurgitation by assessing mitral valve geometry with computed tomography (CT). Methods: This retrospective cohort study reviewed 242 consecutive patients with aortic regurgitation who underwent TAVR between May 2014 and December 2022. Patients with primary or less than moderate mitral regurgitation were excluded. Mitral annular dimensions (area, perimeter, anteroposterior, intercommissural, and trigone-to-trigone diameter), mitral valve tenting geometry (mitral valve tenting area [MVTA] and mitral valve tenting height [MVTH]), and papillary muscle displacement were systematically measured at CT. Mitral regurgitation improvement was assessed at 3 months after TAVR by echocardiography. Logistic regression was performed to explore the association of mitral valve geometry with mitral regurgitation improvement after TAVR. Results: A total of 75 patients (mean age, 74 ± 7 years; 32.0% female) with moderate to severe secondary mitral regurgitation were included in the final analysis. Mitral regurgitation improved in 49 patients and remained unchanged in 26 patients. Mitral annular dimensions, including area, perimeter, anteroposterior, and intercommissural diameter, were associated with mitral regurgitation improvement. MVTA and MVTH were risk factors for sustained mitral regurgitation. In addition, QRS duration >120 ms and atrial fibrillation had an impact on the mitral regurgitation improvement. Mitral annular area (odds ratio [OR], 1.41; 95% confidence interval [CI]: 1.05, 1.90; p = 0.02) and MVTA (OR, 7.24; 95% CI: 1.72, 30.44; p = 0.007) were independent predictors of persistent secondary mitral regurgitation after TAVR. Conclusions: Mitral annular area and MVTA were independent predictors of persistent secondary mitral regurgitation after TAVR.

Background: Transcatheter tricuspid valve intervention (TTVI) has demonstrated safety and efficacy in treating high-risk patients with tricuspid regurgitation (TR). The authors aimed to perform a meta-analysis based on reconstructed time-to-event data to compare the clinical benefit of TTVI with medical therapy (MED). Methods: A systematic literature search was conducted in major databases, including PubMed, Embase, and the Cochrane Library, until 20 October 2023. All studies comparing the outcomes between TTVI and MED were included. The primary outcome was all-cause mortality. The secondary outcomes included heart failure (HF) hospitalization and the composite outcome of all-cause mortality and HF hospitalization. Results: Five studies covering 3826 patients (1146 received TTVI and 2680 received MED) were identified. At 1-year follow-up, TTVI significantly reduced the risk of all-cause mortality compared with MED [hazard ratio (HR) 0.54, 95% CI: 0.39–0.74, P=0.0001]. There was a trend in favor of TTVI in HF hospitalization, although without significant difference (HR 0.70, 95% CI: 0.42–1.18, P=0.18). TTVI was also associated with a decreased risk of composite outcome (HR 0.57, 95% CI: 0.38–0.86, P=0.007). Reconstructed Kaplan–Meier curves illustrated a 1-year overall survival rate of 83.1% in the TTVI group and 68.8% in the MED group. The subgroup analysis of device types yielded consistent results. Conclusions: Compared with MED, TTVI was associated with greater 1-year benefits for patients with symptomatic moderate or greater TR from the aspects of all-cause mortality and HF hospitalization.

Transapical beating-heart mitral repair with chordal implantation system has been considered as an alternative treatment for degenerative mitral regurgitation. This study aimed to assess the feasibility and safety of the E-Chord system (Med-Zenith Medical, Beijing, China) for transapical beating-heart mitral valve repair in a porcine model. Artificial chordae were transapically implanted on the mitral valves of 12 anesthetized pigs under epicardial echocardiographic guidance and secured outside the left ventricular apex. The study endpoints included procedural success, device durability, and tissue response to the device. The procedural success rate was 100% (12/12). All animals were implanted with E-Chord in the anterior and posterior leaflets, respectively, and survived uneventfully until euthanized as planned. During the 180-day follow-up, no animal had significant mitral valve dysfunction. The gross observation showed no evidence of anchor detachment and chordal rupture, and there was no obvious damage or changes to mitral leaflets. Microscopic evaluation revealed that the endothelialization of anchor and chordae was completed 90 days after implantation and there was no evidence of chordal rupture, thrombosis, or infection during the 180-day follow-up. The E-Chord system was found to be feasible and safe for heart-beating mitral chordal implantation in a porcine model. The findings of this study suggest that the E-Chord system may be a potential alternative for the treatment of degenerative mitral regurgitation in humans.

Thoracic aortic aneurysm and dissection (TAAD) is a life-threatening cardiovascular disorder lacking effective clinical pharmacological therapies. The underlying molecular mechanisms of TAAD still remain elusive with participation of versatile cell types and components including endothelial cells (ECs), smooth muscle cells (SMCs), fibroblasts, immune cells, and the extracellular matrix (ECM). The main pathological features of TAAD include SMC dysfunction, phenotypic switching, and ECM degradation, which is closely associated with inflammation and immune cell infiltration. Among various types of immune cells, macrophages are a distinct participator in the formation and progression of TAAD. In this review, we first highlight the important role of inflammation and immune cell infiltration in TAAD. Furthermore, we discuss the role of macrophages in TAAD from the aspects of macrophage origination, classification, and functions. On the basis of experimental and clinical studies, we summarize key regulators of macrophages in TAAD. Finally, we review how targeting macrophages can reduce TAAD in murine models. A better understanding of the molecular and cellular mechanisms of TAAD may provide novel insights into preventing and treating the condition.

Background: Obesity may increase perioperative mortality of acute Stanford type A aortic dissection (ATAAD). However, the available evidence was limited. This study aimed to systematically review published literatures about body mass index (BMI) and perioperative mortality of ATAAD.Methods: Electronic literature search was conducted in PubMed, Medline, Embase and Cochrane Library databases. All observational studies that investigated BMI and perioperative mortality of ATAAD were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Meta-regression analysis was performed to assess the effects of different clinical variables on BMI and perioperative mortality of ATAAD. Sensitivity analysis was performed to determine the sources of heterogeneity. Egger’s linear regression method and funnel plot were used to determine the publication bias.Results: A total of 12 studies with 5,522 patients were eligible and included in this meta-analysis. Pooled analysis showed that perioperative mortality of ATAAD increased by 22% for each 1 kg/m²increase in BMI (OR = 1.22, 95% CI: 1.10–1.35). Univariable meta-regression analysis indicated that age and female gender significantly modified the association between BMI and perioperative mortality of ATAAD in a positive manner (meta-regression on age: coefficient = 0.04,P = 0.04; meta-regression on female gender: coefficient = 0.02,P = 0.03). Neither significant heterogeneity nor publication bias were found among included studies.Conclusions: BMI is closely associated with perioperative mortality of ATAAD. Optimal perioperative management needs to be further explored and individualized for obese patient with ATAAD, especially in elderly and female populations.Trial registration: PROSPERO (CRD42022358619).Graphical BMI and perioperative mortality of ATAAD.