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Breakthrough! Acupuncture TAVI surgery to regain the "porcelain grandma"

Breakthrough! Acupuncture TAVI surgery to regain the "porcelain grandma"

  • Categories:News Channel
  • Author:
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  • Time of issue:2018-03-12 09:55
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(Summary description)

Breakthrough! Acupuncture TAVI surgery to regain the "porcelain grandma"

(Summary description)

  • Categories:News Channel
  • Author:
  • Origin:
  • Time of issue:2018-03-12 09:55
  • Views:
Information

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  On February 10, 2018, the heart team led by Professor Wang Dongjin from Nanjing Drum Tower Hospital teamed up with Professor Guo Yingqiang of Huaxi Hospital to successfully perform transapical TAVI on the porcelain calcified aorta, the patient with severe calcification of the aortic wall. This is the first high-risk porcelain in the country. Transapical (forward) TAVI surgery of the aortic valve.

 

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  The porcelain aorta, the wall of the aorta, is severely calcified and is mainly a diffuse, annular or near-circular, aortic calcification. This disease is more common in the elderly. Most of the patients with porcelain aorta have no obvious discomfort. Usually they are palpated in the aorta during cardiac surgery, or accidentally find calcified aortic contours during chest radiograph examination, so that they can be further examined and confirmed, and aortic calcification will gradually develop. Calcified aortic valve disease. These patients often have high rates of stroke and aortic injuries when performing conventional aortic valve replacement, and blocking the aorta during surgery may result in large aortic dissection hemangioma (almost impossible to block ). Therefore, the porcelain aorta was included in the contraindications of aortic valve replacement.
  Medical History Information
  Ms. Ni, who was admitted to the Nanjing Drum Tower Hospital, was 77 years old. In May of last year, she was prepared to perform a “mitral valve biological removal” operation at the Drum Tower Hospital due to “infective endocarditis,” and severe ascending aorta was found during the operation. Calcification, the porcelain aorta that is unable to block the aorta, can only abandon traditional surgery. This year, the patient’s condition worsened, and mild activity flared up. He was once again admitted to Nanjing Drum Tower Hospital. A detailed assessment of the heart before surgery was as follows: echocardiography revealed moderate-to-severe stenosis with moderate regurgitation in the aortic valve. EF 54 %, orifice area 0.7 cm2, average transvalvular pressure difference 41mmHg, NYHA class III, Euro-ScoreII 14.1%.
  Preoperative evaluation
  Calcification

 

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  Ring

 

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  Left ventricular outflow tract

 

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  Antral tract junction

 

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  Left crown opening

 

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  Right crown opening

 

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  Best shot angle
  Experts believe that surgery is undoubtedly the best choice. Taking into account the age risk, while the traditional surgery needs to block the aorta, and the patient has a diffuse severe calcification of the aortic wall (ie, the porcelain aorta), once the blockade is performed in the surgery will cause a large area of ??the sandwich, so experts consider adopting TAVI technology. Transfemoral retrograde access is often limited by arterial conditions. According to TASCII's findings, patients with severe calcified aortic disease must be accompanied by Polyvasucular disease, a large number of peripheral vascular and cerebrovascular atherosclerosis (ASO), and severe femoral atherosclerosis. It will affect the approach to reverse surgery. Even if it can be successfully delivered into the sheath, it will cause mechanical damage to the inner wall of the aorta when it is introduced into the catheter. The exfoliation of the calcified lesions will cause the dissection and at the same time, the shedding debris will also block the peripheral blood vessels, which will cause many complications and seriously affect the healing after surgery. The transapical approach has the advantages of short access routes and fewer peripheral vascular complications. It can also avoid aortic plaque loss and significantly reduce perioperative neurological complications. For patients, transapical TAVI will undoubtedly become best choice.
  Surgical procedure
  The heart team of Nanjing Drum Tower Hospital teamed up with Prof. Guo Yingqiang of Huaxi Hospital and made a thorough evaluation before surgery. The heart of Ms. Ni had undergone color Doppler ultrasound and CT reconstruction and developed a complete surgical plan. The valve adopts the domestic mature transapical J-Valve?. The J-Valve? valve has been approved by the country to be marketed in China. The model number is complete. There are quite a few doctors in the country who have successful experience in the release of J-Valve?. The operation lasted 1 hour. The intraoperative blood loss was 100ml. There was no complications such as paravalvular leakage, atrioventricular block, and myocardial infarction during the operation. No postoperative cerebral infarction occurred. The patient was detached from the ventilator 2 hours after operation. And the condition is stable.

 

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  Video 1 Aortic root radiography confirms optimal projection angle

 

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  Video 2 Confirm locator position

 

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  Final video after video 3 valve release
  Post-surgery epilogue
  The success of this operation has broken through the traditional surgical exclusion zone and laid the foundation for the application of TAVI technology to such patients. With the development trend of aging society in our country, the incidence of valvular degenerative diseases in the elderly has been increasing, and valvular heart disease has become China's third-biggest heart disease, of which aortic valve disease has become the most common valvular heart disease. For patients with severe aortic valve disease, surgical aortic valve replacement has been the only effective treatment that can prolong life. However, 30% to 50% of elderly patients often have advanced age, poor physical status, severe lesions, or other diseases. No surgery is possible. TAVI has become a routine, effective and safe treatment nowadays, which brings hope for more patients with valvular diseases.

 

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