Good news for "valve surgery without chest opening", today Shanghai Renji Hospital of Shanghai Jiaotong University School of Medicine announced the successful completion of the first transapical TAVI surgery in Shanghai after the launch of the domestic J-Valve valve. Previously, the hospital has successfully completed the first trans-femoral route and the first trans-ascending aortic route TAVI surgery, which means that the multi-path TAVI surgery in cardiovascular surgery is becoming more mature in some tertiary hospitals in China, and can fight for more life chances for different types of patients.

　　The human heart is like an engine, divided into four chambers, the heart valve is equivalent to the "valve" connecting the heart chambers and blood vessels, the valve can not open or close tight (corresponding to valve stenosis or incomplete closure), it will lead to engine malfunction, machine strain, resulting in heart failure, which is the clinical heart valve disease. Surgical aortic valve replacement has been the main treatment modality for symptomatic aortic stenosis, but for patients of advanced age and with concurrent multisystem disease and poor cardiac function, the procedure is highly invasive and risky, and many patients cannot be effectively treated as a result. the advent of TAVI technology brings new hope to such patients, and it is also known as transcatheter aortic valve replacement. TAVI is also known as "valve replacement without chest opening" because of its minimal trauma and quick recovery.

　　However, it is worth noting that not all patients are suitable for TAVI surgery via the femoral route. For example, this case was recently accepted at Renji Hospital. This 82-year-old man was admitted to the hospital with symptoms of chest tightness and shortness of breath after activity. A cardiac ultrasound examination showed that aortic stenosis with severe closure insufficiency was indicated for surgical treatment. However, due to the patient's age, the surgery was risky. After active preoperative examination and evaluation and departmental discussion, the patient was considered to be eligible for the relatively less invasive TAVI surgery. However, the patient had aortic stenosis combined with severe insufficiency of closure, and TAVI could not be performed via the femoral route as well as other routes for patients with combined aortic valve insufficiency.

　　"Patients with aortic valve insufficiency cannot complete TAVI via other routes, and the apical route is currently the only surgical route." Xue Song, director of cardiovascular surgery at Renji Hospital, said the apical route for TAVI is the most appropriate and the only option at this time.

　　On December 7, the cardiovascular surgery department, with the assistance and cooperation of the anesthesiology department, cardiology department, radiology intervention department, operating room and cardiac ultrasound room, was led by Professor Xue Song, with Dr. Yu Zhangjie and Dr. Xiao Jie as the main anesthesiologists, and with the close cooperation of Dr. Ge Heng from the cardiology department and Dr. Qiao Zhiqing from the cardiac ultrasound room, a small incision of 4 cm in length was made through the fifth intercostal space on the left side of the patient to expose the apical part of the heart, do apical loading, imaging, balloon dilatation, valve expansion, and valve dilation. A small incision of 4 cm in length was made through the fifth intercostal space on the left side of the patient. The entire procedure was completed in one step and took less than two hours. The postoperative results of cardiac ultrasound and imaging showed good position and function of the intervening valve, no stenosis or regurgitation, no perivalvular leak, and a successful operation.

　　It is understood that transcatheter aortic valve intervention is a technique developed abroad in the past decade or so for the treatment of aortic valve disease, which is especially suitable for patients with aortic valve stenosis or incomplete closure who are at greater risk of traditional open-heart extracorporeal circulation, and many patients worldwide benefit from this new technology. This technology has not yet been fully spread in China, but the cardiovascular surgery department of Renji Hospital has closely grasped the academic frontier development direction, and has not only built up a mature interventional treatment team, but also sent young doctors to Europe and the United States for many times to learn the new TAVI technology after the development in recent years. At present, Renji Hospital is one of the few units in China that can perform multi-path TAVI surgery.