Trans- apical transcatheter aortic valve replacement for patient with severe pure aortic regurgitation

Abstract

Objective To explore the feasibility of transapical transcatheter aortic valve replacement (TF- TAVR) for patient with severe pure aortic regurgitation (AR). Methods A patientwith severe pure AR underwent TF- TAVR at the Second Affiliated Hospital of Zhejiang University School of Medicine on September 8, 2016, was retrospectively analyzedfor the preoperative assessment, procedural process and the postoperative recovery. Results A patient with pure AR was assessed before TF- TAVR carefully according to the inclusion criteria. General anesthesia and intubation were performed during the procedure. Apex was exposed in the fifth intercostal space under the guidance of X- ray, followed by purse- string suture. Terumo wire crossed aortic valve and went to descending aorta after puncture of apex. J- Valve system was inserted and released step by step. In comparison with severe AR before procedure, no AR was found from transesophageal echocardiography (TEE) monitoring after TF- TAVR. Before discharge, symptom of the patient was relieved and no severe complications such as death, myocardial infarction, pericardial tamponade and aorta dissection, except first degree atrioventricular block was found. Conclusions It is feasible and safe using TF- TAVR for severe pure AR, while follow- up is necessary for the evaluation of long- term prognosis. Key words: Transcatheter aortic valve replacement; Pure aortic regurgitation; Apex