The Application Of Transcatheter Aortic Valve Implantation In Patients With Aortic Valve Diseases-A Single-center Retrospective Study

Objective:To analyze the clinical effects of single-center transcatheter aortic valve implantation（TAVI）in patients with aortic valve diseases.Methods:Consecutive patients who diagnosed with aortic valve diseases and underwent TAVI in our hospital from January 2019 to February 2021 were enrolled and followed up for 9-12 months.Their clinical data,including basic data,test and examination data,complications and so on,were evaluated and analyzed.Results:A total of 45 patients,the mean age was 72.53±7.30 years,were included in this study.Patients with aortic stenosis（AS）and patients with aortic regurgitation（AR）accounted for 84.44%and 15.56%respectively.The mean age of the AS group was higher than the AR group[（73.63±6.37 vs 66.57±9.57）years,P=0.04];The mean valve diameter was 24.47±2.19mm.There were 11cases with right bundle branch block（RBBB）,accounting for 24.4%.The procedural success rate was 100%.During the postoperative hospitalization,a total of 4 patients had died,and 8 patients had paravalvular leak（PVL）,including 6 cases（13.33%）with mild PVL and 2 cases（4.44%）with moderate PVL;5 patients（11.11%）were diagnosed with high atrioventricular block（HAVB）and had accepted to permanent pacemaker implantation（PPI）.And 1 case（2.22%）with acute stroke diagnosed in the first postoperative month.Excluding patients with died and acute stroke,there were 40cases in this postoperative observation study.On echocardiography,the postoperative and follow-up data of the AS group,including mean aortic transvalvular pressure（m PG）,left ventricular end diastolic diameter（LVEDD）,velocity maximum（Vmax）were significantly lower than the baseline,and the left ventricular ejection fraction（LVEF）during the follow-up period was higher than the preoperative,all differences were statically significant（P<0.05）;In the AR group,LVEDD postoperative and follow-up outcomes were lower than preoperative（P<0.05）.Furthermore,the preoperative m PG and Vmax were higher in the AS group than in the AR group（P<0.05）.As for the blood tests results,the count of white blood cell and platelet,the estimated of glomerular filtration rate and the aspartate aminotransferase levels showed self-limiting changes in the short term（7 days）after TAVI,all of which had reached to peak at 1^stday postoperatively and were statistically different from baseline（P<0.05）.And they could regenerate to the normal level during the period.However,the levels of red blood cell and hemoglobin,the prothrombin time,the activated partial thromboplastin time and the fibrinogen and D-Dimer did not recover to preoperative levels in this time,which was significantly different from preoperative（P<0.05）.Both HAVB and PVL were common complications after TAVI;In this study,5patients with HAVB and the preoperative RBBB was the independent risk factors of the HAVB（OR=9.79,95%CI=1.01-99.43,P=0.049）by the univariate and multivariate logistic regression analysis.There were 8 cases with PVL after TAVI,the LVEF of the PVL group was lower than the non-PVL group both postoperatively and during follow-up（P<0.05）;Furthermore,the multivariate logistic regression analysis suggested that both the valve calcium score（OR=1.004,95%CI=1.001-1.008,P=0.019）and the preoperative LVEDD（OR=1.49,95%CI=1.03-2.14,P=0.032）were independent risk of PVL.Conclusion:TAVI has a high safety and efficacy profile for patients with aortic diseases.Multiple complications can occur after TAVI,but most of them are steerable after timely detection and solution.PVL is common after TAVI and has some impact on patient outcomes.