ObjectiveTo summarize and analyze the clinical outcomes of one-stage transcatheter aortic valve replacement (TAVR) combined with transcatheter mitral valve replacement (TMVR) in patients with concomitant severe aortic and mitral valve disease. Methods We retrospectively collected the clinical data of patients who underwent one-stage TAVR and TMVR at Beijing Anzhen Hospital between January 2019 and May 2025. Baseline characteristics, procedural details, and perioperative echocardiographic results were recorded. Survivors were followed regularly, and the incidence of major adverse cardiovascular and cerebrovascular events was assessed. ResultsA total of 12 high-risk patients with concomitant severe aortic and mitral valve disease were included, comprising 7 males with a mean age of (73.3±5.4) years. Aortic valve pathology included mixed lesions (n=1), aortic regurgitation (n=8), and aortic stenosis (n=3). Among them, 7 patients had previously undergone surgical bioprosthetic aortic valve replacement. Mitral valve pathology consisted of bioprosthetic valve degeneration leading to isolated regurgitation (n=8) or mixed lesions (n=4); 11 patients had a prior surgical bioprosthetic mitral valve replacement. All patients successfully underwent one-stage TAVR combined with TMVR, with 10 procedures performed via the transapical approach, 1 via the transfemoral approach, and 1 via a combined transfemoral-transapical approach. Valve deployment was successful in all cases, with an overall device success rate of 91.7%. The median intensive care unit stay was 1.5 (IQR 1.3, 3.4) d. Early postoperative complications included 2 perioperative deaths and 2 cases of gastrointestinal bleeding, with no other major cardiovascular events observed. During follow-up, there were no deaths, permanent pacemaker implantations, and no occurrences of moderate-to-severe valve stenosis, paravalvular leak, or left ventricular outflow tract obstruction. Conclusion This study demonstrates that one-stage TAVR combined with TMVR is safe and effective in selected high-risk patients with concomitant severe aortic and mitral valve disease, and represents a feasible therapeutic option.
ObjectiveTo analyze the differences in clinical outcomes between sutureless aortic valve replacement (SUAVR) and conventional aortic root enlargement (ARE) techniques in patients with small aortic annulus (SAA). MethodsSAA patients undergoing aortic valve replacement at Beijing Anzhen Hospital, Capital Medical University from April 2018 to January 2025 were retrospectively enrolled. Patients were divided into a SUAVR group and an ARE group (including Nicks technique and Manouguian technique) according to surgical approaches. The primary endpoints were postoperative maximum transvalvular pressure gradient and indexed effective orifice area (iEOA). After adjusting for confounding factors using analysis of covariance, the differences in iEOA among the three surgical procedures were compared. ResultsA total of 56 SAA patients were included, with 26 patients in the SUAVR group and 30 patients in the ARE group (19 patients using Nicks technique and 11 patients using Manouguian technique). The median age of SUAVR group was significantly higher than that of ARE group (62.5 years vs. 57.5 years, P=0.035). Female proportions were 84.6% and 83.3%, respectively. In the ARE group, 73.3% of the patients received mechanical valve implantation and 1 patient died during the perioperative period. Postoperative transvalvular pressure gradient was lower in the SUAVR group compared to that in the ARE group [11.5 (8.3, 23.5) mm Hg vs. 19.0 (16.0, 26.0) mm Hg, P=0.005]. Significant differences existed in iEOA among the three techniques (P<0.001): Nicks group (1.10±0.14) cm2/m2, Manouguian group (1.27±0.16) cm2/m2, with SUAVR group showing the highest value (1.69±0.18) cm2/m2. After adjusting for confounding factors, SUAVR still demonstrated significantly higher adjusted iEOA than both Nicks and Manouguian groups (P<0.001). One patient in the ARE group developed moderate prosthesis-patient mismatch. No permanent pacemaker implantation occurred. ConclusionAmong this cohort of SAA patients, those receiving conventional ARE are younger with higher rates of mechanical valve implantation. SUAVR demonstrates favorable perioperative safety while achieving comparable hemodynamic performance to conventional ARE techniques, with significant advantages in iEOA. SUAVR can serve as an effective complementary strategy to traditional ARE techniques in selected SAA patients.