Application of transcatheter aortic valve replacement in treatment of severe aortic stenosis patients complicated with aortic insufficiency

  Objective  To analyze the application of transcatheter aortic valve replacement (TAVR) in treatment of severe aortic stenosis patients complicated with moderate to severe aortic insufficiency.

  Methods  A total of 18 patients diagnosed as severe aortic stenosis complicated with moderate to severe aortic insufficiency were selected as group A, 22 patients diagnosed as simple severe aortic stenosis or only complicated with mild aortic insufficiency in the same period were selected as group B, and all of them were treated with TAVR. All the patients were followed up for 6 months, and the basic data, postoperative transthoracic echocardiography results and clinical adverse events such as mortality and bleeding during follow up were compared between the two groups.

  Results  The average aortic annulus diameter, the proportion of patients with bilobar malformation and the ascending aortic diameter in the group A were significantly higher than those in group B, while the calcification score was significantly lower than that in group B (P < 0.05). There were no significant differences in surgical approach, valve size and valve implantation rate between the two groups (P>0.05). The transaortic velocity and mean transaortic pressure difference immediately after operation and 6 months after operation as well as left ventricular end diastolic diameter at 6 months after operation were significantly lower than those before operation in both groups, while the left ventricular ejection fraction at 6 months after operation was significantly higher than that before operation (P < 0.05). The incidence rates of perivalvular leakage in the group B immediately after operation and 6 months after operation were significantly lower than that in the group A (P < 0.05). There were no significant differences in the incidence rates of complications immediately after operation and 6 months after operation between the two groups (P>0.05).

  Conclusion  For severe aortic stenosis patients complicated with moderate to severe aortic insufficiency, TAVR can effectively reduce the mean transaortic pressure difference and improve cardiac function, but the incidence of perivalvular leakage significantly increase, and most of them are slight or mild perivalvular leakage.