Recently, the Valve Center team of Rizhao Hospital/Rizhao Heart Disease Hospital affiliated with Qingdao University successfully completed the high difficulty transcatheter aortic valve replacement (TAVR) for high-risk patients with large annulus aortic regurgitation. It is reported that this technology is a leading technology in China, providing a new treatment plan for elderly, high-risk, and intolerant patients with aortic valve regurgitation undergoing open chest surgery.
The Valve Center team has successfully performed more than ten TAVR surgeries, but this surgery is the first TAVR surgery for patients with severe aortic regurgitation. The successful completion of this surgery also marks a further improvement in our hospital's technical level in handling difficult TAVR surgeries, which will bring good news to more structural heart disease patients in the future.
Due to his advanced age and intolerance to surgical procedures, TAVR brought hope to 76 year old Uncle Li. Ten years ago, he experienced occasional chest tightness and wheezing after physical activity. He went to a local hospital for treatment and was diagnosed with "aortic valve reflux". After the medication symptoms improved, he was discharged from the hospital. However, he experienced intermittent chest tightness and discomfort thereafter. In the past year, Uncle Li has felt more chest tightness and asthma than before, so he came to Qingdao University Affiliated Rizhao Hospital/Rizhao Heart Disease Hospital Cardiology Outpatient Clinic for treatment.
After being admitted to the second main consultation group of the cardiology department and completing cardiac ultrasound, Uncle Li was diagnosed with "heart valve disease and severe aortic insufficiency". Due to the patient's advanced age and concomitant heart failure, the surgical risk is high. After multidisciplinary consultation and evaluation, the cardiology team believes that TAVR surgery is Uncle Li's only opportunity.
In the past, TAVR surgery was generally only used for severe aortic valve stenosis, while minimally invasive heart valve replacement with high difficulty heart technology was used. Aortic valve regurgitation has always been a relatively restricted area for TAVR. Due to the lack of anchoring structures, patients with severe aortic valve regurgitation are more difficult to perform TAVR surgery, requiring more accurate structural judgment and more clever release techniques. However, in experienced hospitals, TAVR treatment for severe aortic valve regurgitation is feasible for high-risk surgical patients.
Due to the patient's risk factors such as hypertension and hyperlipidemia, as well as concomitant heart failure, the cardiology team provided symptomatic treatments such as lipid-lowering and stabilizing plaques, adjusting heart function, etc., and then performed aortic CTA examination. The results showed that the patient's aortic valve annulus was large, the aortic sinus and ascending aorta were dilated, the valve anchoring plane was small, the valve was prone to slide, the valve release was difficult, and the surgical difficulty was extremely high.
Based on previous rich experience in TAVR surgery and weighing the pros and cons, the valve center team conducted repeated MDT discussions, precise evaluations, and developed detailed surgical plans and risk plans. After obtaining the consent of the family, the team ultimately decided to challenge this difficult surgery.
On the day of the surgery, under the guidance of Professor Pan Wenzhi from Zhongshan Hospital affiliated with Fudan University, the Valve Center team led by Director Li Zhaofeng and Medical Doctor Gao Tingwen successfully implanted the largest valve TAV30 during the surgery. The valve position was fixed after the surgery, and a follow-up cardiac ultrasound showed good aortic valve function, without intravalvular or perivalvular reflux, coronary and conduction block complications. The surgery was successfully completed.
The "Heart Gate" has resumed operation, and Uncle Li feels an unprecedented sense of comfort. With the careful care of medical staff and the systematic early rehabilitation training of the cardiac rehabilitation team, Uncle Li can get out of bed and move around the next day after surgery. He has been successfully discharged from the hospital recently.
TAVR brings longer survival benefits and higher quality of life to patients
"TAVR provides a new approach for the treatment of aortic valve disease, with the advantages of non thoracotomy, minimal trauma, and fast recovery. Especially for elderly and high-risk patients who cannot tolerate open chest surgery and have surgical contraindications, it provides a chance for 'rebirth', greatly improving their cardiac function and quality of life." Dr. Gao Tingwen, a cardiologist from Rizhao Hospital/Rizhao Heart Disease Hospital affiliated with Qingdao University, said, "Compared to conventional TAVR, TAVR for aortic valve regurgitation often has higher technical difficulty and requirements, requiring interdisciplinary cooperation with rich clinical experience and strong technical capabilities. Our valve center team has rich experience in structural heart disease, and currently TAVR surgery is routine in hospitals." To carry out more advanced and precise diagnosis and treatment plans for many patients with heart valve diseases, while also bringing long-term survival benefits and higher quality of life to patients
In recent years, Qingdao University Affiliated Rizhao Hospital/Rizhao Heart Disease Hospital has closely followed the forefront development of the world's cardiovascular field, repeatedly completed high difficulty surgeries, worked together to overcome difficulties, continuously explored and innovated, and made breakthroughs in the field of structural heart disease while striving for excellence in coronary intervention and electrophysiological pacing technology.
