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West China Hospital, Professor Guo Yingqiang team to complete the world's first severe AR combined with acute B-mode simultaneous TAVR + TEVR surgery

West China Hospital, Professor Guo Yingqiang team to complete the world's first severe AR combined with acute B-mode simultaneous TAVR + TEVR surgery

  • Categories:News Channel
  • Author:
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  • Time of issue:2018-01-21 11:09
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(Summary description)

West China Hospital, Professor Guo Yingqiang team to complete the world's first severe AR combined with acute B-mode simultaneous TAVR + TEVR surgery

(Summary description)

  • Categories:News Channel
  • Author:
  • Origin:
  • Time of issue:2018-01-21 11:09
  • Views:
Information

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  ▌ On January 5, the heart surgery team led by Professor Guo Yingqiang successfully completed the world's first severe AR complicated with B type dissection simultaneous TAVR + TEVR surgery after meticulous preoperative discussion and program preparation.
  ▌ Patient one is a 70-year-old man who was admitted to the hospital due to "severe chest pain without apparent inducement, tear-off, radiating to the back, and restlessness." CT suggests that the aorta is punctuated under the left subclavian Artery openings near the aortic valve leaf cloverleaf, valve leaflets thickening, no significant calcification, the measured ring diameter of the annulus is 27.5mm. Ultrasound Tip: Aortic dissection aneurysm (Stanford B type), left ventricular enlargement, severe aortic regurgitation. After evaluation and discussion, Heart Team decided to perform aortic endoluminal stent-graft + 27mm J-Valve? valve for catheter replacement.
  ▌ patients with the tear in the large bend on the aortic side tear to the distal left subclavian, and accumulated to the right femoral artery, short aortic thoracic abdominal embolization. Abdominal cavity and superior mesenteric artery true cavity blood supply, left and right kidney by the true and false lumen at the same time blood supply.
  定 anchoring the area located in the left subclavian artery opening, the diameter of the distal left anterior descending artery is about 34mm, bilateral femoral artery diameter of about 6.5mm.
  ▌ surgery in West China Hospital cardiac hybridization surgery room to complete.
  ▌ due to calcification of the right femoral artery heavier selected left femoral artery as the access vessel, left leg tissue incision, left femoral artery, puncture, upper arterial sheath, loach guide wire and pig tail contrast catheter, the catheter The first segment pushed to the thoracic vertebra about T10 level, withdrawal guidewire, contrast angiography, verify the catheter in the true lumen, the catheter into the ascending aorta angiography, well marked.

 

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  ▌ Control blood pressure to stabilize at 90, locate by gold mark, place Medtronic 28080 restrictive bracket in the descending aorta, place Medtronic 36200 bracket under the anchored left clavicle opening, and both brackets overlap approximately 30 mm

 

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  Temporary pacing leads were placed through the internal jugular vein

 

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  DR to determine the location of apical punctures, left in the fifth intercostal line minimally invasive incision 3cm. Suspension of the pericardium and purse sack. Femoral artery puncture into the 5F sheath, the body after heparinization placed Pigtail catheter to the aortic root (ACT> 250s), select the best DR projection angle, to obtain the best guide section.
  ▌ ultrasound and DR-guided apical puncturing, loach guide wire placed 2.6m into the ascending aorta, into the vascular sheath, using JR4 catheter guide wire across the aortic arch to the bifurcation of the abdominal aortic bifurcation, replacement of 2.6m plus stiff guide wire, Expand the apical puncture with 14Fcook dilatation sheath.
  Adjust the position of the DSA head according to the CTA results, showing the best aortic valve flap positions, and deliver a 27 mmJ-Valve @ interventional valve into the apex.


  1.Release the positioning element and pull back to the three aortic sinus, angiography confirm the positioning of the correct position.

 

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  2.Retract the valve, the stent valve into the aortic valve area under the guidance of the positioning member

 

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  3. Rotate the release button, the valve release (due to the self-expanding valve, the whole process without RVP and any hemodynamic fluctuations)

 

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  4.Recycler, release valve, angiography and TEE realistic valve in good position, no paravalvular leakage, celiac, mesenteric artery, bilateral renal artery imaging was good

 

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  ▌ suture apical incision, apical bleeding, close the incision. Patients were admitted to the ICU ward, the signs of stability. The entire operation less than 60 minutes, the patient recovered well.

 

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  ▌ The heart team of West China Hospital of Sichuan University, led by Professor Guo Yingqiang, is not only the heart center of the country that has the largest volume of apically involved valves, but also has held 12 training courses for all centers in China and trained 34 heart centers in JACC , JACC intervention, and International Journal of Cardiology, published 10 original articles (non-review) of articles with high impact factors related to J-Valve interventional valve surgery. The cumulative impact factor exceeded 40 points. TAVI completed the treatment of reflux alone Reference published literature is currently the world's first.

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