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Combined Transcatheter Replacement of Aortic Root and Mitral Valve in an Acute Preclinical Study

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Abstract

The study aimed to evaluate the early feasibility of endovascular replacement of ascending aorta, aortic root (including aortic valve, AV), and mitral valve (MV) in one procedure with two self-expandable prostheses. Aortic valved-fenestrated-bifurcated (AVFB) and MV endografts of 10 healthy pigs (60–65kg) were customized and delivered through transapical and transseptal approach, respectively. Both endografts were successfully deployed in nine pigs (90%). Eight survived over 24 h, and the acute success rate was 80%. There was no significant increase in the mean trans-aortic, trans-mitral, and trans-LVOT pressure gradients after the operation. No coronary artery or LVOT obstruction and other electrocardiographic abnormality occurred. The transvalvular and paravalvular leak rates were low for both valves. Endovascular replacement of ascending aorta, AV, and MV in one procedure might be feasible.

Graphical Abstract

Combined transcatheter replacement of aortic root and mitral valve in one procedure

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References

  1. Zannis, K., Deux, J. F., Tzvetkov, B., Nakashima, K., Loisance, D., Rahmouni, A., et al. (2009). Composite freestyle stentless xenograft with Dacron graft extension for ascending aortic replacement. The Annals of Thoracic Surgery, 87(6), 1789–1794.

    Article  Google Scholar 

  2. Chandraratna, P. A., Nimalasuriya, A., Kawanishi, D., Duncan, P., Rosin, B., & Rahimtoola, S. H. (1984). Identification of the increased frequency of cardiovascular abnormalities associated with mitral valve prolapse by two-dimensional echocardiography. The American Journal of Cardiology, 54(10), 1283–1285.

    Article  CAS  Google Scholar 

  3. Gott, V. L., Cameron, D. E., Alejo, D. E., Greene, P. S., Shake, J. G., Caparrelli, D. J., et al. (2002). Aortic root replacement in 271 Marfan patients: a 24-year experience. The Annals of Thoracic Surgery, 73(2), 438–443.

    Article  Google Scholar 

  4. David, T. E., Armstrong, S., Maganti, M., & Ihlberg, L. (2008). Clinical outcomes of combined aortic root replacement with mitral valve surgery. The Journal of Thoracic and Cardiovascular Surgery, 136(1), 82–87.

    Article  Google Scholar 

  5. Gleason, T. G., Reardon, M. J., Popma, J. J., Deeb, G. M., Yakubov, S. J., Lee, J. S., et al. (2018). 5-Year outcomes of self-expanding transcatheter versus surgical aortic valve replacement in high-risk patients. Journal of the American College of Cardiology, 72(22), 2687–2696.

    Article  Google Scholar 

  6. Unger, P., Rosenhek, R., Dedobbeleer, C., Berrebi, A., & Lancellotti, P. (2011). Management of multiple valve disease. Heart, 97(4), 272–277.

    Article  Google Scholar 

  7. Feng, J., Bao, X., Li, T., Zhao, Y., Wu, M., Liu, J., et al. (2020). Endovascular reconstruction from aortic valve to aortic arch using 1-piece valved fenestrated bifurcated endografting. Journal of the American College of Cardiology, 75(16), 2090–2092.

    Article  Google Scholar 

  8. Li, T., Bao, X., Zhao, Y., Li, Z., Xu, Z., Zeng, Z., et al. (2020). Thoracic aortic computed tomography angiography in swine: establishment of a baseline for endovascular evaluation of the ascending aorta. Interactive Cardiovascular and Thoracic Surgery, 31(2), 248–253.

    Article  Google Scholar 

  9. Navia, J. L., Baeza, C., Maluenda, G., Kapadia, S., Elgharably, H., Sadowski, J., et al. (2017). Transcatheter mitral valve replacement with the NaviGate stent in a preclinical model. EuroIntervention, 13(12), e1401–e1409.

    Article  Google Scholar 

  10. Li, T., Bao, X., Feng, J., Li, Z., Liu, J., Zhao, Y., et al. (2019). Endovascular reconstruction from aortic valve to aortic arch using one-piece valved-fenestrated stent graft with a branch: a proof-of-concept study. The Heart Surgery Forum, 22(5), E380–E384.

    Article  Google Scholar 

  11. Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin 3rd., J. P., Guyton, R. A., et al. (2014). 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 129(23), 2440–2492.

    Article  Google Scholar 

  12. Svensson, L. G., Pillai, S. T., Rajeswaran, J., Desai, M. Y., Griffin, B., Grimm, R., et al. (2016). Long-term survival, valve durability, and reoperation for 4 aortic root procedures combined with ascending aorta replacement. The Journal of Thoracic and Cardiovascular Surgery, 151(3), 764–774.e4.

    Article  Google Scholar 

  13. Cortés, C., Amat-Santos, I. J., Nombela-Franco, L., Muñoz-Garcia, A. J., & Gutiérrez-Ibanes, E. (2016). Mitral regurgitation after transcatheter aortic valve replacement: prognosis, imaging predictors, and potential management. JACC: Cardiovascular Interventions, 9(15), 1603–1614.

    PubMed  Google Scholar 

  14. Kindya, B., Ouzan, E., Lerakis, S., Gonen, E., Babaliaros, V., Karayel, E., et al. (2018). Degenerative mitral regurgitation predicts worse outcomes in patients undergoing transcatheter aortic valve replacement. Catheterization and Cardiovascular Interventions, 92(3), 574–582.

    Article  Google Scholar 

  15. Blanke, P., Naoum, C., Dvir, D., Bapat, V., Ong, K., Muller, D., et al. (2017). Predicting LVOT obstruction in transcatheter mitral valve implantation: concept of the Neo-LVOT. JACC. Cardiovascular Imaging, 10(4), 482–485.

    Article  Google Scholar 

  16. Eltchaninoff, H., Prat, A., Gilard, A., Leguerrier, A., Blanchard, D., Fournial, G., et al. (2011). Transcatheter aortic valve implantation: early results of the FRANCE (French Aortic National CoreValve and Edwards) registry. European Heart Journal, 32(2), 191–197.

    Article  Google Scholar 

  17. Tarantini, G., Mojoli, M., Purita, P., Napodano, M., D'Onofrio, A., Frigo, A., et al. (2015). Unravelling the (arte) fact of increased pacemaker rate with the Edwards SAPIEN 3 valve. EuroIntervention, 11(3), 343–350.

    Article  Google Scholar 

  18. Piazza, N., Lauzier, P., & Mylotte, D. (2016). Transcatheter aortic valve replacement and new conduction abnormalities/permanent pacemaker: can we achieve the intended implant depth? JACC: Cardiovascular Interventions, 9(3), 255–258.

    PubMed  Google Scholar 

  19. Kammler, J., Blessberger, H., Fellner, F., Kypta, A., Lambert, T., Engl, M., et al. (2016). Implantation depth measured by 64-slice computed tomography is associated with permanent pacemaker requirement following transcatheter aortic valve implantation with the Core Valve(®) system. Journal of Cardiology, 67(6), 513–518.

    Article  Google Scholar 

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Acknowledgements

The authors thank all of the animal experiment investigators.

Funding

This study was supported by the National Natural Science Foundation of China [81330034, 81770476, 81970208] and Shanghai Rising-Star Program [20QA1408900].

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Author notes

  1. Yuxi Zhao, Xianhao Bao and Tao Li contributed equally to this work.

Authors and Affiliations

  1. Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, People’s Republic of China

    Yuxi Zhao, Xianhao Bao, Tao Li, Mingwei Wu, Zhaoxiang Zeng, Aikebaierjiang Ainiwaer, Jian Zhou, Jiaxuan Feng, Rui Feng & Zaiping Jing

  2. Department of Cardiovascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People’s Republic of China

    Tao Li

  3. Department of General Surgery, Second People’s Hospital, Kashi Region, Xinjiang, Uygur Autonomous Region, People’s Republic of China

    Aikebaierjiang Ainiwaer

Authors
  1. Yuxi Zhao
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  2. Xianhao Bao
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  3. Tao Li
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  4. Mingwei Wu
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  5. Zhaoxiang Zeng
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  6. Aikebaierjiang Ainiwaer
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  7. Jian Zhou
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  8. Jiaxuan Feng
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  9. Rui Feng
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  10. Zaiping Jing
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Contributions

Conception and design (JZP, FJX, FR, ZJ), analysis and interpretation (ZZX, WMW, AA), data collection (ZYX, BXH, LTC, ZZX, WMW, AA), drafting the article (ZYX, LT, BXH, FJX), critical revision of the article (all authors), final approval of the article (all authors), and overall responsibility (JZP).

Corresponding authors

Correspondence to Jiaxuan Feng, Rui Feng or Zaiping Jing.

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Competing Interests

The authors declare no competing interests.

Human Studies

No human studies were carried out by the authors for this article.

Animal Studies

The care and use of laboratory animals were followed and approved by our Institutional Animal Care and Use Committee (protocol no. 2017-02002).

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Associate Editor Adrian Chester oversaw the review of this article

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Zhao, Y., Bao, X., Li, T. et al. Combined Transcatheter Replacement of Aortic Root and Mitral Valve in an Acute Preclinical Study. J. of Cardiovasc. Trans. Res. 14, 1156–1164 (2021). https://doi.org/10.1007/s12265-021-10129-5

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  • DOI: https://doi.org/10.1007/s12265-021-10129-5

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