Early Prognosis of Reduction Ascending Aortoplasty in Patients With Aortic Valve Disease: A Single Center's Experience.

BACKGROUND:Dilatation of the ascending aorta tends to develop in individuals with aortic valve disease. Reduction ascending aortoplasty (RAA) is an alternative procedure to ascending aortic replacement. This study was designed to identify the early prognosis of RAA for patients with aortic valve disease and dilatation of the ascending aorta.METHODS:From January 2010 to December 2013, 102 patients with aortic valve disease and ascending aortic dilatation who had undergone aortic valve replacement combined with RAA were enrolled. Fifty-seven patients with bicuspid aortic valve (BAV group) and 45 patients without BAV (non-BAV group) were analyzed. The study endpoints were postoperative death, reoperation, stroke, and aorta-related adverse events.RESULTS:Follow-up data were obtained from all patients. The mean follow-up time was 38.8 ± 13.0 months. More patients with mitral valve disease and tricuspid insufficiency were present in the non-BAV group. More patients with ascending aorta larger than 45 mm were present in the BAV group. Two patients died, and 1 patient experienced a stroke. There were no reoperations or aorta-related adverse events. The mean expansion degree and rate of ascending aorta were 0.39 ± 0.26 cm and 1.3 ± 0.8 mm/year, respectively, in patients with aortic redilatation. Redilatation was observed in the BAV group (37.0 ± 5.0 mm vs 35.5 ± 4.6 mm; p = 0.009), whereas the non-BAV group had no significant change.CONCLUSIONS:Reduction ascending aortoplasty shows good early results in patients with aortic valve disease and dilatation of the ascending aorta. Redilatation tends to happen in patients with BAV, and long-term follow-up is necessary.

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Transapical transcatheter aortic valve implantation using the J-Valve system: A 1-year follow-up study.

OBJECTIVE:Transcatheter aortic valve implantation has become a routine procedure to treat screened inoperable or high-risk patients. In this study, we present the first outcome of echocardiographic midterm using a new second-generation transcatheter aortic valve implantation system, the J-Valve system (Jie Cheng Medical Technologies, Suzhou, China), in patients with aortic stenosis or aortic regurgitation.METHODS:From July 2014 to June 2015, 21 patients with isolated aortic valve disease at high risk for open surgery received transapical transcatheter aortic valve implantation using the J-Valve system. The primary end point was a combined efficacy end point after 1 year, which included all-cause mortality after more than 30 days and failure of current therapy for aortic stenosis or aortic regurgitation requiring hospitalization for symptoms of valve-related cardiac decompensation or prosthetic heart valve dysfunction. Secondary end points were cardiovascular mortality, major stroke, and life-threatening, disabling, or major bleeding after 6 and 12 months.RESULTS:The mean age of the study cohort was 75.52 ± 5.22 years, the European System for Cardiac Operative Risk Evaluation II score was 11.33% ± 1.28%, and the mean logistic European System for Cardiac Operative Risk Evaluation I score was 31.13% ± 9.68%. Transcatheter aortic valve implantation with the J-Valve system was successfully performed in 19 of the 21 patients (90.5%). For patients with aortic stenosis, 12-month follow-up echocardiography demonstrated an increase in mean effective valve area from 0.62 ± 0.17 cm2 to 1.52 ± 0.35 cm2 and a decrease in transvalvular mean gradient from 61 ± 15 mm Hg to 18 ± 9 mm Hg. All surviving patients (n = 18) reported improvements in at least 1 of the New York Heart Association classes. The combined ratio of successful implantation and absence of adverse events in our cohort (n = 21) was 76.19%.CONCLUSIONS:The J-Valve system exhibits a convincing midterm performance and is a safe and feasible procedure with low perioperative and postoperative complications.

Early Prognosis of Reduction Ascending Aortoplasty in Patients With Aortic Valve Disease: A Single Center's Experience.

BACKGROUND:Dilatation of the ascending aorta tends to develop in individuals with aortic valve disease. Reduction ascending aortoplasty (RAA) is an alternative procedure to ascending aortic replacement. This study was designed to identify the early prognosis of RAA for patients with aortic valve disease and dilatation of the ascending aorta.METHODS:From January 2010 to December 2013, 102 patients with aortic valve disease and ascending aortic dilatation who had undergone aortic valve replacement combined with RAA were enrolled. Fifty-seven patients with bicuspid aortic valve (BAV group) and 45 patients without BAV (non-BAV group) were analyzed. The study endpoints were postoperative death, reoperation, stroke, and aorta-related adverse events.RESULTS:Follow-up data were obtained from all patients. The mean follow-up time was 38.8 ± 13.0 months. More patients with mitral valve disease and tricuspid insufficiency were present in the non-BAV group. More patients with ascending aorta larger than 45 mm were present in the BAV group. Two patients died, and 1 patient experienced a stroke. There were no reoperations or aorta-related adverse events. The mean expansion degree and rate of ascending aorta were 0.39 ± 0.26 cm and 1.3 ± 0.8 mm/year, respectively, in patients with aortic redilatation. Redilatation was observed in the BAV group (37.0 ± 5.0 mm vs 35.5 ± 4.6 mm; p = 0.009), whereas the non-BAV group had no significant change.CONCLUSIONS:Reduction ascending aortoplasty shows good early results in patients with aortic valve disease and dilatation of the ascending aorta. Redilatation tends to happen in patients with BAV, and long-term follow-up is necessary.

Reply.

Transapical transcatheter aortic valve implantation using the J-Valve system: A 1-year follow-up study.

OBJECTIVE:Transcatheter aortic valve implantation has become a routine procedure to treat screened inoperable or high-risk patients. In this study, we present the first outcome of echocardiographic midterm using a new second-generation transcatheter aortic valve implantation system, the J-Valve system (Jie Cheng Medical Technologies, Suzhou, China), in patients with aortic stenosis or aortic regurgitation.METHODS:From July 2014 to June 2015, 21 patients with isolated aortic valve disease at high risk for open surgery received transapical transcatheter aortic valve implantation using the J-Valve system. The primary end point was a combined efficacy end point after 1 year, which included all-cause mortality after more than 30 days and failure of current therapy for aortic stenosis or aortic regurgitation requiring hospitalization for symptoms of valve-related cardiac decompensation or prosthetic heart valve dysfunction. Secondary end points were cardiovascular mortality, major stroke, and life-threatening, disabling, or major bleeding after 6 and 12 months.RESULTS:The mean age of the study cohort was 75.52 ± 5.22 years, the European System for Cardiac Operative Risk Evaluation II score was 11.33% ± 1.28%, and the mean logistic European System for Cardiac Operative Risk Evaluation I score was 31.13% ± 9.68%. Transcatheter aortic valve implantation with the J-Valve system was successfully performed in 19 of the 21 patients (90.5%). For patients with aortic stenosis, 12-month follow-up echocardiography demonstrated an increase in mean effective valve area from 0.62 ± 0.17 cm2 to 1.52 ± 0.35 cm2 and a decrease in transvalvular mean gradient from 61 ± 15 mm Hg to 18 ± 9 mm Hg. All surviving patients (n = 18) reported improvements in at least 1 of the New York Heart Association classes. The combined ratio of successful implantation and absence of adverse events in our cohort (n = 21) was 76.19%.CONCLUSIONS:The J-Valve system exhibits a convincing midterm performance and is a safe and feasible procedure with low perioperative and postoperative complications.