Changsha Central Hospital successfully performed the first transcatheter aortic valve replacement

During surgery.

Red network moment january 25 news (correspondent Xiao Ying Chen Chun) recently, Changsha Central Hospital Cardiology Department successfully completed the first transcatheter aortic valve replacement (VitaFlow TAVR) surgery, compared with the traditional open chest replacement valve surgery, the operation trauma is small, fast recovery, low cost, the next day after the operation can get out of bed activities, get the unanimous praise of patients and families.

The patient, Grandma Wang, 67, had a history of type 2 diabetes and was admitted to the hospital for "repeated chest tightness and shortness of breath for 13 years, aggravated for 3 days". It is understood that Grandma Wang was diagnosed with severe stenosis of the aortic valve before 2015 due to chest tightness and shortness of breath, and did not pay attention to it at that time, in the past two weeks, she herself felt that chest tightness and shortness of breath gradually worsened, as well as sweating, vomiting, dizziness and other uncomfortable symptoms. For further treatment, on 11 January, he was admitted to Ward 6 of the Cardiology Department of the hospital, and the ultrasound was diagnosed with calcification of the aortic valve and severe stenosis.

Chen Chun, the doctor in charge, gave Grandma Wang a detailed evaluation, considering that her discomfort symptoms were mainly caused by severe stenosis of the aortic valve, and the solution was only to replace the aortic valve, but the patient was old and had many underlying diseases, and it was difficult to tolerate the traditional surgical open-breast valve replacement surgery. Fully considering the condition of the elderly, the medical team after discussion and communication with patients and families, decided to implement the latest transcatheter aortic valve replacement for the elderly, this surgical method does not require open chest, small trauma, and fast recovery. The Department of Cardiology invited personnel from the departments of Thoracic Surgery, Ultrasound, Anesthesiology, and Integrated ICU to set up a TAVR team.

On January 14, the TAVR team conducted a detailed preoperative discussion and preoperative strategy analysis, and determined the model of implanted balloon and valve through radiological CT examination to determine the model of implanted balloon and valve based on the anatomical details of the aortic root, the degree of valve calcification, the diameter of the blood vessels and the basis for selecting the valve model. During the operation, Jiang Luping, director of the Department of Cardiology, with the assistance of multidisciplinary team members, under general anesthesia, first puncture of the left subclavian vein, implanted a temporary pace electrode, the electrode was placed in the right ventricular apex, and then punctured the left femoral artery, established a secondary approach, and then punctured the right femoral artery as the main approach, after the success of the cross-valve, a 22mm balloon predistention observation was given, showing that coronary blood flow was normal, according to the preoperative plan, the valve was implanted, the high release was selected, the implantation depth was perfect, and the valve work was stable. With the cooperation of multiple disciplines, after 1 hour and 30 minutes of intense and orderly operation, after valve implantation, ultrasound assessed that the valve was in good position and morphological integrity, and no obvious perivalular leakage was seen. There were no relevant complications during or after the operation, and the operation was successfully completed.

The day after the operation, Grandma Wang was transferred from the comprehensive ICU back to the 6th ward of the Department of Cardiology, and Director Jiang Luping carefully examined the situation of the elderly, without chest pain, nausea, retching, sweating, numbness in the left upper limb and other uncomfortable symptoms. The head nurse of the department, Song Juan, led the nursing team to assist Grandma Wang in early rehabilitation exercises, and the elderly can move appropriately indoors at the bedside without discomfort. Seeing that the elderly recovered so quickly and avoided the pain of open surgery and could be discharged soon, the elderly family members were grateful to the medical staff.

Jiang Luping introduced that the heart is equivalent to the engine of the human body, responsible for providing fresh blood to the organs of the whole body. There are four sets of valves in the heart, like four one-way valves, which control the blood to maintain a one-way circulation and maintain the body's important circulatory supply. The aortic valve is one of the most important valves that controls the blood supply between the heart and other vital organs of the body. Due to factors such as degenerative changes in old age, rheumatic diseases, congenital malformations and other factors, the aortic valve will appear stenosis, and the more serious aortic stenosis will have an important impact on the human body, and in severe cases, there may be chest pain, syncope, dyspnea and even sudden death.

Aortic valve replacement is the only effective treatment for aortic stenosis, and aortic valve replacement includes traditional surgical aortic valve replacement and transcatheter and transcutaneous aortic valve replacement. Surgical aortic valve replacement is the replacement of the diseased aortic valve through open surgery, which is more suitable for young patients and patients with relatively low surgical risk. However, it has many drawbacks such as high surgical trauma, the need for cardiopulmonary bypass and cardiac arrest, and slow postoperative recovery, especially for patients who are not suitable for the elderly, thin, more comorbidities and high risk of surgery. Transcatheter aortic valve replacement refers to the insertion of a fully assembled artificial aortic valve transcatheter into the lesion aortic valve and functionally completing the replacement of the aortic valve. TAVR has many advantages such as small trauma, fast recovery, short operation time, short hospitalization time, less postoperative pain, etc., and patients can go to the ground the next day, which has the advantages of small trauma, fast recovery and low mortality. The successful development of this transcatheter aortic valve replacement surgery marks that the Cardiovascular Department of the hospital, as a key discipline in Hunan Province, has reached a new level in the cardiac intervention valve replacement technology in the field of structural heart disease, which will relieve the pain and bring good news to more patients with heart valve disease.