Current clinical data and experience of TAVR in China

Yaling Han, Editor-in-Chief of the Chinese Journal of Cardiology (CJC), reviews two of the most remarkable papers published in the Journal. Since transcatheter aortic valve replacement (TAVR) was first introduced into global clinical practice over 20 years ago, a vast portfolio of high-quality clinical data has accumulated, confirming the safety and efficacy of TAVR across the entire spectrum of surgical risk.1 In China along with population ageing, we are facing a huge disease burden due to degenerative valvular diseases including severe aortic stenosis (AS). Moreover, patients presenting for TAVR in China have a significantly higher frequency of bicuspid valve morphology and more severe calcification of leaflets,2 which presents challenges for TAVR in this population. TAVR was introduced later in China than in many parts of the world; however, in recent years, since domestic devices became available, the procedure has developed rapidly and clinical data and experience have accumulated.3,4 This was recently reported in the CJC with a contribution entitled ‘Perioperative serious complications in patients undergoing transcatheter aortic valve replacement: a single-centre experience’ by Prof. Yaling Han and colleagues from the General Hospital of Northern Theatre Command5 in Shenyang. In this single-centre retrospective study, patients with AS who underwent TAVR from May 2016 to November 2020 in the General Hospital of Northern Theatre Command were included and the occurrence of severe complications during the perioperative period was recorded. Severe complications included all-cause death, urgent conversion to thoracotomy, coronary artery occlusion, peripheral vascular approach complications, severe cerebrovascular events, moderate or severe perivalvular leak, valve-in-valve implantation (due to the high-implantation position of the first valve), pacemaker implantation (due to new high-degree atrioventricular block), etc. A total of 119 patients were included, including 64 males and 55 females, the mean age was (73.9 ± 6.9) years. The valve implantation was unsuccessful in 3 out of 119 patients (2.5%). There were 39 cases of severe complications during the perioperative period (Table 1), including 1 death (0.8%), 2 cases of thoracotomy (1.7%), 2 cases of coronary artery occlusion (1.7%), 8 cases of peripheral vascular complications (6.7%), 1 new severe cerebrovascular event (0.8%), 3 cases of moderate or severe perivalvular leak (2.5%), 8 cases of valve-in-valve implantation (6.7%), and 14 cases of permanent pacemaker implantation (11.8%). The incidence of permanent pacemaker implantation and valve-in-valve implantation did not significantly decrease with the accumulation of experience, while the incidence of all-cause death, coronary artery occlusion, and peripheral vascular approach complications during the perioperative period post-TAVR showed a decreasing trend after 30 cases through the accumulation of procedure-related experience. Complications after transcatheter aortic valve replacement in patients with severe aortic stenosis Complications after transcatheter aortic valve replacement in patients with severe aortic stenosis Another publication ‘Left ventricular guidewire pacing during transcatheter aortic valve replacement’ by Prof. Yongjian Wu and colleagues from Beijing Fuwai Hospital investigated the safety and efficacy of direct rapid pacing via the valve delivery guidewire during TAVR.6 This is a single-centre retrospective study. Thirteen patients, who underwent TAVR with left ventricular (LV) guidewire pacing from October 2019 to December 2019 in Fuwai Hospital, were included. The pacing success rate, as well as the incidence of major adverse cardiac events during hospitalization and at 3 months after discharge, was recorded. There were seven male and six female patients in this cohort, and the mean age was (73.8 ± 8.3) years. Among the 13 patients, 9 were tricuspid aortic valves, 3 were bicuspid aortic valves, and 1 was a degenerated bioprosthetic surgical aortic valve. Transfemoral TAVR was successfully performed in all the 13 cases using direct LV wire pacing. The pacing success rate was 100%. The results of aortography showed that there were no regurgitation in 7 cases, mild regurgitation in 5 cases and moderate regurgitation in 1 case. Three patients required temporary pacing during the procedure due to new high-degree atrioventricular block, among them 1 patient was implanted with a permanent pacemaker during hospitalization and the other 2 patients recovered within 24 h after TAVR. In another case, there was no significant change in the electrocardiogram during TAVR, and complete heart block occurred 10 days after TAVR and was then treated with a permanent pacemaker. The other 10 patients began to carry out bedside activities and rehabilitation training 24 h after TAVR. There were no death, myocardial infarction, stroke, or other major adverse cardiac events during hospitalization or at 3-month follow-up after discharge. Therefore, direct LV wire pacing during TAVR is a simple, reproducible, safe and effective option, which provides reliable and sustained stimulation with a low complication rate. Conflict of interest: none declared.