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Zhang J, Kong XQ, Gao XF, Chen J, Chen X, Li B, Shao YB, Wang Y, Jiang H, Zhu JC, Zhang JJ, Chen SL. Transfemoral transcatheter aortic valve replacement with VitaFlow TM valve for pure native aortic regurgitation in patients with high surgical risk: Rationale and design of a prospective, multicenter, and randomized SEASON-AR trial. Am Heart J 2024; 271:76-83. [PMID: 38412895 DOI: 10.1016/j.ahj.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Previous studies primarily demonstrated that transfemoral transcatheter aortic valve replacement (TAVR) with self-expanding valve appeared to be a safe and feasible treatment for patients with pure native aortic regurgitation (AR). However, the routine application of transfemoral TAVR for pure AR patients lacks support from randomized trials. TRIAL DESIGN SEASON-AR trial is a prospective, multicenter, randomized, controlled, parallel-group, open-label trial, involving at least 20 sites in China, aiming to enroll 210 patients with pure native severe AR and high surgical risk. All enrolled patients are randomly assigned in a 1:1 fashion to undergo transfemoral TAVR with VitaFlowTM valve and receive guideline-directed medical therapy (GDMT) or to receive GDMT alone. The primary endpoint is the rate of major adverse cardiac events (MACE) at 12 months after the procedure, defined by the composite of all-cause mortality, disabling stroke, and rehospitalization for heart failure. The major secondary endpoints encompass various measures, including procedure-related complications, device success, 6-minute walk distance, and the occurrence of each individual component of the primary endpoint. After hospital discharge, follow-up was conducted through clinical visits or telephone contact at 1, 6, and 12 months. The follow-up will continue annually until 5 years after the index procedure to assess the long-term outcomes. CONCLUSION SEASON-AR trial is the first study designed to investigate the clinical efficacy and safety of transfemoral TAVR with a self-expanding valve in patients with pure native severe AR with inoperable or high-risk, as compared to medical treatment only.
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Affiliation(s)
- Juan Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiang-Quan Kong
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Xiang Chen
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Bo Li
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Yi-Bing Shao
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Jian-Cheng Zhu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Peigh G, Puthumana JJ, Bonow RO. Aortic Regurgitation and Heart Failure: Advances in Diagnosis, Management, and Interventions. Heart Fail Clin 2023; 19:285-296. [PMID: 37230644 DOI: 10.1016/j.hfc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This review discusses the contemporary clinical evaluation and management of patients with comorbid aortic regurgitation (AR) and heart failure (HF) (AR-HF). Importantly, as clinical HF exists along the spectrum of AR severity, the present review also details novel strategies to detect early signs of HF before the clinical syndrome ensues. Indeed, there may be a vulnerable cohort of AR patients who benefit from early detection and management of HF. Additionally, while the mainstay of operative management for AR has historically been surgical aortic valve replacement, this review discusses alternate procedures that may be beneficial in high-risk cohorts.
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Affiliation(s)
- Graham Peigh
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, 676 North St. Clair Suite 600, Chicago, IL 60611, USA.
| | - Jyothy J Puthumana
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, 676 North St. Clair Suite 600, Chicago, IL 60611, USA
| | - Robert O Bonow
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, 676 North St. Clair Suite 600, Chicago, IL 60611, USA
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Chen Y, Ferdous MM, Kottu L, Zhao J, Zhang HL, Wang MY, Niu GN, Liu QR, Zhou Z, Zhao ZY, Zhang Q, Feng DJ, Zhang B, Li ZA, Merkus D, Lv B, Xu HY, Song GY, Wu YJ. Can Measuring the 'Dual Anchors of Aorta' Enhance the Success Rate of TAVR?-A Single-Center Experience. J Clin Med 2023; 12:jcm12031157. [PMID: 36769804 PMCID: PMC9918180 DOI: 10.3390/jcm12031157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Chronic severe aortic regurgitation (AR) has a poor long-term prognosis, especially among old-age patients. Considering their advancing age, the surgical approach of aortic valve replacement may not always be the best alternative modality of treatment in such patients. Therefore, this study's primary goal was to provide an initial summary of the medium- and short-term clinical effectiveness of transcatheter aortic valve replacement (TAVR) guided by accurate multi-detector computed tomography (MDCT) measurements in patients with severe and chronic AR, especially in elderly patients. METHODS The study enrolled retrospectively and prospectively patients diagnosed with severe AR who eventually underwent TAVR procedure from January 2019 to September 2022 at Fuwai cardiovascular Hospital, Beijing. Baseline information, MDCT measurements, anatomical classification, perioperative, and 1-year follow-up outcomes were collected and analyzed. Based on a novel anatomical categorization and dual anchoring theory, patients were divided into four categories according to the level of anchoring area. Type 1, 2, and 3 patients (with at least two anchoring regions) will receive TAVR with a transcatheter heart valve (THV), but Type 4 patients (with zero or one anchoring location) will be deemed unsuitable for TAVR and will instead receive medical care (retrospectively enrolled patients who already underwent TAVR are an exception). RESULTS The mean age of the 37 patients with severe chronic AR was 73.1 ± 8.7 years, and 23 patients (62.2%) were male. The American Association of Thoracic Surgeons' score was 8.6 ± 2.1%. The MDCT anatomical classification included 17 cases of type 1 (45.9%), 3 cases of type 2 (8.1%), 13 cases of type 3 (35.1%), and 4 cases of Type 4 (10.8%). The VitaFlow valve (MicroPort, Shanghai, China) was implanted in 19 patients (51.3%), while the Venus A valve (Venus MedTech, Hangzhou, China) was implanted in 18 patients (48.6%). Immediate TAVR procedural and device success rates were 86.5% and 67.6%, respectively, while eight cases (21.6%) required THV-in-THV implantation, and nine cases (24.3%) required permanent pacemaker implantation. Univariate regression analysis revealed that the major factors affecting TAVR device failure were sinotubular junction diameter, THV type, and MDCT anatomical classification (p < 0.05). Compared with the baseline, the left ventricular ejection fraction gradually increased, while the left ventricular end-diastolic diameter remained small, and the N-terminal-pro hormone B-type natriuretic peptide level significantly decreased within one year. CONCLUSION According to the results of our study, TAVR with a self-expanding THV is safe and feasible for patients with chronic severe AR, particularly for those who meet the criteria for the appropriate MDCT anatomical classification with intact dual aortic anchors, and it has a significant clinical effect for at least a year.
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Affiliation(s)
- Yang Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Md Misbahul Ferdous
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Lakshme Kottu
- Department of Experimental Cardiology, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
| | - Jie Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
- Correspondence: (J.Z.); (G.-Y.S.); (Y.-J.W.)
| | - Hong-Liang Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Mo-Yang Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Guan-Nan Niu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Qing-Rong Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Zheng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Zhen-Yan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Qian Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - De-Jing Feng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Bin Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Zi-Ang Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Daphne Merkus
- Department of Experimental Cardiology, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-University München, 81377 Munich, Germany
| | - Bin Lv
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Hai-Yan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Guang-Yuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Correspondence: (J.Z.); (G.-Y.S.); (Y.-J.W.)
| | - Yong-Jian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
- Correspondence: (J.Z.); (G.-Y.S.); (Y.-J.W.)
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Zhang W, Guan LN, Wang BZ, Huo Q. Transapical aortic valve replacement for quadricuspid aortic valve with severe aortic regurgitation which caused multiorgan failure. J Card Surg 2022; 37:5595-5598. [PMID: 36423255 DOI: 10.1111/jocs.17196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND We present the case of a patient who underwent successful transapical aortic valve implantation in a severe quadricuspid aortic valve (QAV) with severe regurgitation and multiorgan failure. CASE SUMMARY A 57-year-old man experienced intermittent palpitation and shortness of breath for 6 months. The condition deteriorated in the past month and caused multiorgan failure. The echocardiography and computed tomography angiography revealed severe aortic regurgitation due to congenital QAV. The aortic valve replacement was successfully performed in this high-risk patient using a J-Valve system. Postoperation and follow-up were uneventful. CONCLUSION The J-Valve system effectively treated QAV regurgitation with good clinical outcomes in this case.
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Affiliation(s)
- Weimin Zhang
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li-Na Guan
- Department of Cardiac Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Bao-Zhu Wang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qiang Huo
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Kadoba K, Watanabe R, Hashimoto M, Morinobu A, Terao C, Yoshifuji H. Comment on: Different treatment options for Takayasu arteritis patients with moderate-to- severe aortic regurgitation: long-term outcomes. Rheumatology (Oxford) 2021; 60:e290-e291. [PMID: 33617627 DOI: 10.1093/rheumatology/keab184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Keiichiro Kadoba
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan
| | - Ryu Watanabe
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan
| | - Chikashi Terao
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan.,Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.,Clinical Research Center, Shizuoka General Hospital, University of Shizuoka, Shizuoka, Japan.,Department of Applied Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan
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Khan SA, Baron SJ. Point: patients with native aortic regurgitation can be treated with transcatheter aortic valve implantation. Heart 2021; 107:1938-1941. [PMID: 33863759 DOI: 10.1136/heartjnl-2021-319179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/28/2021] [Accepted: 04/04/2021] [Indexed: 11/04/2022] Open
Abstract
Approximately 2% of people between the ages of 70 and 83 suffer from moderate or greater aortic regurgitation (AR) in the United States. Left untreated, this disease is progressive and fatal; however, up to 8% of patients with AR, who meet the criteria for surgical intervention, do not receive treatment. As such, there is a pressing need to address the lack of treatment options for the thousands of patients with AR who meet a class I indication for aortic valve replacement but who still do not receive surgery. The advent of transcatheter aortic valve implantation (TAVI) has significantly altered the paradigm of treatment for valvular heart disease and is now a well-established therapeutic option for patients with severe aortic stenosis. While transcatheter devices dedicated for the treatment of AR are under investigation, they are not commercially available at this time. Nevertheless, there is a growing body of data that demonstrate acceptable safety and efficacy for the off-label use of current TAVI devices for the treatment of severe AR. Given the dearth of treatment options for inoperable patients with severe AR, available TAVI devices should be considered for this patient population.
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Affiliation(s)
- Sahoor A Khan
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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