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Second Xiangya Hospital of Central South University successfully completed the first case of transapical TAVI in Hunan Province

Second Xiangya Hospital of Central South University successfully completed the first case of transapical TAVI in Hunan Province

  • Categories:News Channel
  • Author:
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  • Time of issue:2017-12-01 13:04
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(Summary description)

Second Xiangya Hospital of Central South University successfully completed the first case of transapical TAVI in Hunan Province

(Summary description)

  • Categories:News Channel
  • Author:
  • Origin:
  • Time of issue:2017-12-01 13:04
  • Views:
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  On November 22, 2017, under the guidance of experts including Zhou Xinmin, director of Cardiovascular Surgery at Xiangya Hospital and Zhou Shenghua, director of Cardiovascular Medicine, Professor Zhao Yuan and Professor Fang Zhenfei successfully completed the first transvaginal valve replacement surgery in the province TAVI). Jiecheng Medical will bring a wonderful review of surgery.

 

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  Patient history data
  Male, 78 years old.
  ▌ Chief Complaint: Patient 76 years old, female, due to repeated chest tightness, shortness of breath 5 years, the recent 3 months increased admission.
  ▌ admission diagnosis: valvular heart disease, severe aortic regurgitation, cardiac function grade Ⅲ, hypertension 2.
  ▌ heart ultra-color ultra: left ventricular 60mm, EF38%, aortic valve stenosis (mild to moderate) and closed incomplete (severe), left ventricular enlargement, left ventricular thickening.


  Surgical strategy
  ▌ Preoperative, the Ministry of Health organizes extra-cardiac, intracardiac, imaging, anesthesia and nursing experts conducted multidisciplinary consultations, from the diagnosis and treatment measures to surgical risk, complications, anatomy, surgical approach, prevention of complications All aspects of in-depth analysis and discussion, and patients and their families fully informed informed consent, and ultimately determine the choice of TAVR for the patient's preferred program. After Heart Team accurate CT assessment: trilobes and other large leaflets, valve thickening, no calcification, non-sinusoidal mild prolapse, perimeter aortic annulus diameter 24.33, the discussion decided to use 25mm J-Valve? Mitac? interventional valve undergoes TAVI surgery.

 

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  Surgical procedure
  ▌ Operation time: November 22, 2017
  ▌ steps:
  1. Take the supine position, conventional disinfection shop towel, intravenous composite anesthesia, puncture the left radial artery to monitor blood pressure. Puncture the right femoral vein, implanted temporary pacing lead to the right apex of the heart.
  2. Puncture the right femoral artery into the aortic sinus by inserting a 6F pig tail catheter and monitor aortic blood pressure. According to the previous CT measurement data to adjust the position of the C arm so that the three valve sinus simultaneously displayed and in the same plane. Do a left chest incision, open the pericardium, apex purse suture, and set aside 6 pads. Implantation of the j-tip soft guide wire into the ascending aorta after apical puncturing was performed with the guidewire inserted into the JR4 guide catheter. The guide wire is guided to the distal end of the descending aorta. Replace 1.8m ultra-slip hard wire. Remove the JR4 catheter.
  3. The 14F arterial sheath was placed along the guidewire, the sheath was removed, the balloon was delivered along the guidewire, and the pacemaker ventricular rate was determined 180 times after the balloon was in place. The balloon was dilated at a SBP of 50mmHg.

 

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  4. Assemble the 25mmJ-Valve? Mitral Valve with the diameter of the annulus measured by preoperative CT and echocardiography and route it along the stiff guidewire into the valved catheter delivery system above the plane of the aortic valve.

 

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  5. In the pig tail catheter to assist positioning, assisted by aortic root apexography to release the positioning member to ensure that the positioning member is located in the native valve sinus, the valve down to the annulus plane, open the valve stent, stent release catheter delivery system, pig tail Aortic root duct angiography showed: artificial valve position, open well, the coronary ostial was not affected, no paravalvular leakage and reflux. TEE and aortic rootography showed mitral valve opening and closing is not affected, artificial aortic valve works well.

 

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  Surgical results
  ▌ the entire surgical procedure for a total of 30 minutes, the patient recovered well.

  The J-Valve? Human Intervention Bio-heart Valve, a new generation of interventional valves, was approved by the State Food and Drug Administration for clinical use in April 2017. Its indications include aortic valve stenosis, aortic insufficiency and aorta Stenosis combined with incomplete closure is currently the world's only officially approved to treat aortic valve insufficiency involved in the valve, but also a one-stop solution of aortic valve disease.

 

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