ObjectiveTo compare the clinical efficacy of left ventricular wire pacing with traditional right ventricular lead pacing in transcatheter aortic valve replacement. MethodsPerioperative data of patients undergoing transcatheter aortic valve replacement at the Second Hospital of Hebei Medical University from January 2022 to June 2023 were collected. Patients were divided into a left ventricular wire pacing group and a right ventricular lead pacing group based on the pacing method during the procedure, and the clinical data of the two groups were compared and analyzed. ResultsA total of 102 patients were included, with 35 patients in the left ventricular wire pacing group [20 males and 15 females, age (69.2±3.1) years] and 67 patients in the right ventricular lead pacing group [37 males and 30 females, age (70.2±3.7) years]. The hemodynamic characteristics of both groups (peak flow velocity, peak transvalve pressure difference, left ventricular ejection fraction) showed significant improvement post-operation compared to pre-operation (P<0.05). There was no statistically significant difference between the two groups in terms of pacing success rate and surgical complications (P>0.05). Compared to the right ventricular lead pacing group, the left ventricular wire pacing group had shorter operation time [(76.3±17.2) min vs. (86.1±15.3) min, P=0.004] and X-ray exposure time [(18.2±6.1) min vs. (26.2±4.3) min, P<0.001], and lower total hospitalization cost [(213±28) thousand yuan vs. (262±25) thousand yuan, P<0.001]. ConclusionThe safety and reliability of left ventricular wire pacing in transcatheter aortic valve replacement are similar to those of traditional right ventricular lead pacing. Moreover, it can significantly reduce the operation and X-ray exposure time and decrease the total clinical hospitalization cost, making it a viable alternative to traditional right ventricular lead pacing.
ObjectiveTo investigate the new-onset conduction block after transcatheter aortic valve replacement (TAVR) and summarize the relevant experience. Methods The perioperative data of TAVR patients in the Second Hospital of Hebei Medical University from January 2016 to February 2023 were collected, and the new-onset incidence of conduction block after TAVR was analyzed retrospectively. Results Finally 352 patients were included, including 225 males and 127 females, with an average age of (67.2±5.1) years, among whom 256 patients were treated with Venus-A valves, 69 patients with Vita-Flow valves, and 27 patients with J-Valve valves. There were 38 (10.8%) patients of new-onset postoperative block. There were 6 (1.7%) patients of new-onset postoperative grade Ⅲ atrioventricular block, including 5 (2.0%) patients of Venus-A and 1 (1.4%) patient of Vita-Flow. Conduction function was restored in 2 patients within 14 days after surgery, and failed to be restored in 4 patients, who then received permanent pacemaker implantation in the Department of Cardiology. There were 27 (7.7%) patients of new left bundle branch block after surgery, including 22 (8.6%) patients of Venus-A, 4 (5.8%) patients of Vita-Flow and 1 (3.7%) patient of J-Valve; and conduction function was restored within 7 days after surgery in 23 patients, and 5 (1.4%) patients developed new right bundle branch blocks after surgery including 4 (1.5%) patients of Venus-A and 1 (1.4%) patient of Vita-Flow. Conclusion New-onset conduction block is a common complication after TAVR, and the new-onset rate of left bundle branch block is the highest, followed by the grade Ⅲ atrioventricular block. Mastering reasonable methods and applying appropriate strategies can effectively reduce the new-onset rate of postoperative conduction block and improve the overall success rate of TAVR surgery.
ObjectiveTo analyze the short-term clinical outcomes of emergency conversion to surgery during transcatheter aortic valve replacement (TAVR). Methods Clinical data of patients who underwent emergency surgical conversion from TAVR in the Department of Cardiovascular Surgery, the Second Hospital of Hebei Medical University, from 2018 to 2023 were collected. Postoperative follow-up results at 1 month were recorded. Results A total of 253 patients underwent TAVR, of whom 11 (4.3%) required emergency conversion to surgery. Among these 11 patients, 7 were male and 4 were female, with a mean age of (69.55±5.01) years. The primary cause for emergency surgical conversion was valve stent displacement (63.6%), followed by left ventricular perforation/rupture (18.2%) and significant perivalvular regurgitation persisting after a second valve implantation (18.2%). One (9.1%) patient died intraoperatively. Among the 10 surviving patients, postoperative complications included pulmonary infection in 8 patients, severe pneumonia in 7, pleural effusion in 3, liver dysfunction in 8, renal dysfunction in 3, upper gastrointestinal bleeding in 5, cerebrovascular complications in 1, atrial fibrillation in 1, ventricular premature contractions in 1, atrioventricular block in 1, and complete left bundle branch block in 3. At 1-month postoperative follow-up, one additional patient died, yielding a 30-day mortality rate of 18.2% after TAVR emergency surgical conversion. The quality of life improved significantly compared to preoperative status in 9 (81.8%) patients, and no patients were readmitted for cardiovascular diseases. Conclusion The incidence of emergency conversion to surgery during TAVR is low, but the rates of surgical complications and 30-day postoperative mortality are high. Nevertheless, when severe complications occur during TAVR, emergency conversion to surgery can still yield satisfactory short-term clinical outcomes for a majority of these patients.
Objective To evaluate the short-term efficacy of transcatheter aortic valve replacement (TAVR) using Venus A-Plus valve delivery system in patients with severe aortic stenosis. Methods The clinical data of patients undergoing TAVR in our hospital from August 2018 to March 2022 were collected and they were divided into a Venus A-Plus and a Venus A group according to the type of valve delivery system used. The perioperative data of the two groups were compared. ResultsA total of 121 patients were included, including 70 patients in the Venus A-Plus group [45 males and 25 females with a mean age of (67.81±6.62) years], and 51 patients in the Venus A group [33 males and 18 females with a mean age of (68.25±7.01) years]. All patients underwent TAVR, and the postoperative hemodynamic features (left ventricular ejection fraction, mean cross-valve pressure difference, peak flow rate) were significantly improved (P<0.05). There was no statistical difference in surgical success rate, all-cause mortality, conversion to thorax opening, valve-in-valve placement, moderate or above perivalvular regurgitation, new left bundle branch block or new right bundle branch block between the two groups (P>0.05). Conclusion TAVR with Venus A-Plus valve delivery system in patients with severe aortic stenosis shows comparable efficacy to the first-generation Venus A system and is satisfactory, safe and reliable.
Objective To evaluate the efficacy and safety of the Perclose ProGlide vascular closure system for femoral artery access site closure in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). Methods We retrospectively analyzed the perioperative data of patients who underwent transfemoral TAVR at the Second Hospital of Hebei Medical University from January 2023 to September 2025. Based on the closure method for the main arterial access site, patients were divided into a surgical group (surgical cut-down and repair) and a ProGlide group (pre-closure with the ProGlide system). The effectiveness of access site closure and clinical outcomes were compared between the two groups. Results A total of 413 patients were included, with 183 in the surgical group and 230 in the ProGlide group. The surgical group consisted of 112 males and 71 females, with a mean age of (68.2±6.3) years. The ProGlide group included 141 males and 89 females, with a mean age of (69.2±5.2) years. No mortality was observed in either group. In the ProGlide group, immediate hemostasis was successfully achieved with two ProGlide devices in 220 (95.7%) patients. An additional 10 patients required a third device to achieve hemostasis. At 6 hours post-procedure, no active bleeding was observed. Subcutaneous hematoma occurred in 5 patients, all of whom resolved after 10 minutes of manual compression. The final hemostasis success rate was 97.8% for the ProGlide group. In the surgical group, no active bleeding or subcutaneous hematoma was observed at 6 hours post-procedure, yielding a hemostasis success rate of 100.0%. Poor wound healing occurred in 28 patients and access site-related nerve injury in 41 patients in the surgical group. In contrast, no patients of poor wound healing or nerve injury were reported in the ProGlide group. No major vascular complications occurred in either group. At 6 hours post-procedure, the Kolcaba Comfort Scale score was significantly higher in the ProGlide group than that in the surgical group (P<0.001). Compared to the surgical group, the ProGlide group had significantly shorter procedure times and postoperative hospital stays (both P<0.001). ConclusionThe Perclose ProGlide vascular closure system provides effective closure for the main femoral access site in transfemoral TAVR. Compared with the conventional surgical cut-down method, it offers the advantages of being less invasive, enabling faster recovery, and providing greater procedural convenience, making it a valuable technique worthy of broader clinical adoption.
ObjectiveTo systematically compare the perioperative efficacy and safety of transcatheter aortic valve replacement (TAVR) via peripheral arterial versus transapical approaches for patients with pure native aortic regurgitation (PNAR). MethodsPatients with PNAR who underwent TAVR in the Department of Cardiac Surgery, The Second Hospital of Hebei Medical University from 2015 to 2023 were retrospectively enrolled and divided into a peripheral group and a transapical group according to surgical approach. The baseline data, intraoperative procedural parameters, complication profiles and postoperative recovery indicators were collected for intergroup comparative analysis. ResultsA total of 82 patients were enrolled, including 40 patients in the peripheral group [28 males, 12 females, aged (68.25±7.62) years] and 42 patients in the transapical group [30 males, 12 females, aged (67.81±8.15) years]. No perioperative death occurred in either group. The procedural success rate and device success rate were significantly lower in the peripheral group than those in the transapical group (all P<0.05), while the overall success rate showed no statistically significant intergroup difference (P=0.506). There were no significant differences between the two groups in the incidences of moderate or greater paravalvular regurgitation, coronary artery obstruction, new-onset stroke, peripheral vascular complications or conversion to open thoracotomy (all P>0.05). The rates of valve-in-valve implantation, new-onset transient atrioventricular block and permanent pacemaker implantation were remarkably higher in the peripheral group (all P<0.05). The duration of ICU stay and postoperative hospital stay were markedly shorter in the peripheral group (all P<0.05). Repeated-measures analysis of variance with Greenhouse-Geisser correction for sphericity assumption revealed statistically significant main effects of time, main intergroup effects and group-time interaction effects for two normally distributed cardiac function indicators including left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) (all P<0.05). Patients in the peripheral group suffered more severe baseline cardiac impairment and higher preoperative surgical risk stratification, and achieved prominent catch-up improvement in LVEF and LVEDD after surgery; the levels of the two indicators were nearly equivalent between the two groups on postoperative day 7. N-terminal pro-B-type natriuretic peptide decreased significantly in both groups after surgery with a larger decline magnitude in the peripheral group, and the levels of the two groups became comparable on postoperative day 7. ConclusionBoth peripheral arterial access and transapical TAVR are safe and effective for PNAR treatment with equivalent overall perioperative success rates. Surgical approach should be selected individually based on aortic root anatomy, baseline cardiac function and surgical risk stratification in clinical practice. Clinicians should stay alert to potential long-term risks of peripheral approach, including compromised valve durability and limited accessibility to subsequent coronary intervention.
ObjectiveTo analyze the short-term clinical efficacy and prognosis of one-stop transcatheter aortic valve replacement (TAVR)+percutaneous coronary intervention (PCI) in the treatment of aortic valve disease with coronary heart disease. MethodsThe clinical data of patients with aortic valve disease complicated with coronary heart disease who underwent one-stop TAVR+PCI treatment at the Department of Cardiovascular Surgery, the Second Hospital of Hebei Medical University from January 2018 to June 2023 were retrospective analyzed. The preoperative and postoperative clinical data were compared, and 1-month follow-up results were recorded. ResultsA total of 37 patients were enrolled, including 22 males and 15 females, with an average age of 69.14±6.47 years. Thirty-six patients recovered and were discharged after the surgery, and 1 (2.7%) patient died during the surgery. Self-expanding TAVR valves were implanted through the femoral artery in all patients. One coronary artery was opened by PCI in 35 (94.6%) patients, and two coronary arteries were opened by PCI in 2 (5.4%) patients. All PCI opened arteries had a stenosis>70%. During the postoperative hospitalization, the complications included pulmonary infection in 11 (30.6%) patients, severe pneumonia in 10 (27.8%) patients, liver function injury in 14 (38.9%) patients, renal function injury in 5 (13.9%) patients, cerebral infarction in 1 (2.8%) patient, atrial fibrillation in 1 (2.8%) patient, ventricular premature beats in 2 (5.6%) patients, atrioventricular block in 2 (5.6%) patients, and complete left bundle branch block in 5 (13.9%) patients. The median postoperative ventilation assistance time was 12.0 (0.0, 17.0) h, the ICU monitoring time was 1.0 (0.0, 2.0) d, and the postoperative hospitalization time was 5.0 (4.0, 7.0) d. There was a significant improvement in the New York Heart Association cardiac function grading after surgery (P<0.001). After surgery, there were 21 (58.3%) patients had minor perivalve leakage, 6 (16.7%) patients had minor to moderate perivalve leakage, and no moderate or above degree of perivalve leakage. After one month of postoperative follow-up, 36 patients showed significant improvement in heart function. There were no patients with recurrent acute coronary syndrome, re-PCI, or cardiovascular system disease related re-hospitalization. ConclusionThe one-stop TAVR+PCI treatment for patients with aortic valve disease and coronary heart disease can obtain satisfactory short-term clinical efficacy, which is worth further trying and studying.