11 results on '"Zhao, Zhen-Gang"'
Search Results
2. Treating patients with excessively large annuli with self-expanding transcatheter aortic valves: insights into supra-annular structures that anchor the prosthesis.
- Author
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Xiong TY, Liao YB, Li YJ, Chen F, Ou Y, Wang X, Wang ZJ, Li X, Zhao ZG, Meng W, Feng Y, and Chen M
- Subjects
- Aortic Valve diagnostic imaging, Aortic Valve surgery, Humans, Multidetector Computed Tomography, Prosthesis Design, Retrospective Studies, Treatment Outcome, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement
- Abstract
Background: Some patients referred for transcatheter aortic valve replacement (TAVR) have excessively large annuli (ELA) without device options according to current sizing charts. This retrospective study aims to summarize the presentation and outcomes of ELA patients receiving first-generation self-expanding valves., Methods: The TAVR database was reviewed in search for cases of self-expanding valves. Patients who had annuli exceeding the perimeter limit on the device sizing chart were referred to as the ELA group. Patients who had annuli within the range covered by the two largest sizes and received the corresponding valve size served as the control group (CG). Baseline, procedures, outcomes, and imaging characteristics on multislice computed tomography (MSCT), such as native anatomy and postimplant stent geometry, were compared., Results: A total of 28 patients were included in the ELA group and 82 in the CG. The patients in the ELA group were younger than those in the CG (72.5 ± 6.2 vs. 75.4 ± 5.8 years, P = 0.03). The median intended perimeter oversizing in relation to the annulus in the ELA group was much smaller than in the CG (-0.4 [-4.6, 4.1] % vs. 16.1 [11.7, 20.8] %, P < 0.01). The calcium burden in the aortic root was around 1.3-fold greater in the ELA group than the CG (756.0 [534.5, 1670.9] vs. 582.1 [310.3, 870.9] mm
3 , P = 0.01). The need for second valve implantation was higher in ELA (21.4% vs. 12.2%, P = 0.23) but no valve embolization was encountered. The 1‑year follow-up was comparable, including >mild paravalvular leak., Conclusion: Under cautious patient selection using MSCT, TAVR with self-expanding valves in patients with ELA appears feasible. Supra-annular structures likely provide the extra anchoring., (© 2020. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)- Published
- 2021
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3. Comparison of third generation balloon-expandable Edwards Sapien 3 versus self-expandable Evolut R in transcatheter aortic valve implantation: a meta-analysis.
- Author
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Li YM, Tsauo JY, Liao YB, Zhao ZG, and Chen M
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- Humans, Postoperative Complications, Prosthesis Design, Stroke Volume, Treatment Outcome, Ventricular Function, Left, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement instrumentation
- Abstract
Background: The 3rd generations of transcatheter heart valve system, including Edwards SAPIEN S3 (ES3) and Medtronic's Evolut R, has been developed to specifically improve the safety of transcatheter aortic valve implantation (TAVI). The aim of this work was to provide a summary effect estimate of the peri-procedural characteristics and clinical outcome of patients treated with ES3 versus the Evolut R., Methods: We conducted a literature search of PubMed, Ovid and EMBASE (2002 to 2018). Two authors extracted the data independently. The safety and feasibility of Sapien 3 and Evolut R were compared by odds ratios (ORs) with 95% confidence intervals (CIs) in inverse variance method., Results: After a multi-step assessment, a total 6 studies were finally included, yielding 1,664 patients, of which, 768 (46%) used ES3 and 896 (54%) used Evolut R. There was no statistical difference with device success rate (OR 1.15, 95% CI: 0.70-1.91, I2 =0%), 30-day mortality [OR: 0.72 (0.33-1.57), I2 =0%], pre-dilation rate, 30-day stroke, bleeding complication (BC) (major and life-threating), major vascular complication (VC), and paravalvular leakage between the two groups. However, the ES3 group was associated with a higher risk of acute kidney injury (AKI), higher mean aortic valve gradient and better mean left ventricular ejection fraction (LVEF) after TAVR procedure. Moreover, the Evolut R group had a higher rate of post-dilation and new permanent pacemaker implantation (PPMI)., Conclusions: Both devices had demonstrated excellent procedural success rate and short-term safety. At 30-day follow-up, both devices shared similar rates of mortality, BC, VC, stroke, and paravalvular leakage (PVL). However, the rate of AKI was higher in the ES3 group, and the rate of PPM was higher in the Evolut R group.
- Published
- 2020
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4. Reshaping bicuspid aortic valve stenosis with an hourglass-shaped balloon for transcatheter aortic valve replacement: A pilot study.
- Author
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Zhao ZG, Feng Y, Liao YB, Li YJ, Xiong TY, Ou YW, Wang ZJ, Wei JF, Peng Y, Wei X, Xu YN, Pedersen WR, Chen M, and Leon MB
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Balloon Valvuloplasty adverse effects, Balloon Valvuloplasty mortality, Bicuspid Aortic Valve Disease diagnostic imaging, Bicuspid Aortic Valve Disease mortality, Bicuspid Aortic Valve Disease physiopathology, Female, Humans, Male, Pilot Projects, Postoperative Complications etiology, Risk Factors, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality, Treatment Outcome, Aortic Valve Stenosis surgery, Balloon Valvuloplasty instrumentation, Bicuspid Aortic Valve Disease surgery, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement instrumentation
- Abstract
Objectives: We evaluated the safety and usefulness of preparatory anatomical reshaping with a geometric hourglass-shaped balloon to optimize transcatheter aortic valve replacement (TAVR) outcomes in bicuspid aortic valve (BAV) stenosis., Background: TAVR has been increasingly performed for BAV stenosis; however, technical challenges remain. Procedural results are suboptimal given unfavorable valvular anatomies., Methods: Eligible patients with BAV stenosis were enrolled to undergo aortic valve predilatation with the hourglass-shaped TAV8 balloon before TAVR using the self-expandable Venus A-Valve. Procedural details and outcomes were compared to a sequential group of patients with BAV who underwent TAVR with the same device following preparatory dilatation using a cylindrical balloon., Results: A total of 22 patients were enrolled in the TAV8 group and 53 were included in the control group. Valve downsizing was less common in the TAV8 group (36.4 vs. 67.9%; p = .012). Stable valve release and optimal implant depth were consistently achieved in the TAV8 group with no requirement for a second valve (0 vs. 17.0%; p = .039) and with higher device success rates (100.0 vs 77.4%; p = .014). Residual aortic regurgitation graded as ≥mild was less common in the TAV8 group (13.6 vs 45.3%; p = .009). Mortality was similar (0 vs. 3.8%; p = 1); no major/disabling stroke or conversion to open-heart surgery was seen in either group within 30 days., Conclusions: Compared with standard cylindrical balloon valvuloplasty, preparatory reshaping with the hourglass-shaped balloon before self-expandable TAVR in BAV was associated with significantly better procedural results and may encourage more promising outcomes., (© 2020 Wiley Periodicals, Inc.)
- Published
- 2020
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5. Understanding the Interaction Between Transcatheter Aortic Valve Prostheses and Supra-Annular Structures From Post-Implant Stent Geometry.
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Xiong TY, Li YJ, Feng Y, Liao YB, Zhao ZG, Mylotte D, Wei X, Xu YN, Peng Y, Wei JF, Zheng MX, Zhou X, Meng W, Piazza N, and Chen M
- Subjects
- Aged, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Female, Heart Valve Prosthesis Implantation adverse effects, Hemodynamics, Humans, Male, Multidetector Computed Tomography, Prosthesis Design, Retrospective Studies, Treatment Outcome, Aortic Valve surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Stents
- Abstract
Objectives: The authors sought to better understand the stent geometry of the Lotus valve after transcatheter aortic valve replacement (TAVR) and its potential implications for valve size selection., Background: The authors hypothesized that the greatest interference between the frame and aortic valvar complex occurs across the aortic valve leaflets., Methods: The authors retrospectively analyzed the multidetector computed tomography (MDCT) scans of 32 consecutive patients undergoing Lotus valve (Boston Scientific, Natick, Massachusetts) implantation. The prosthesis cross section was analyzed at 3-mm increments along its length. The plane where the frame had the smallest area was defined as the waist. The corresponding plane of the waist on pre-procedural MDCT was identified by surrounding structures such as calcium deposits, commissural fusion, and commissural gaps, and was referred to as the supra-annulus. The spline of the supra-annulus was circumscribed with reference to the post-implant stent geometry at the waist., Results: The waist was 5.8 ± 1.7 mm higher than the native annulus on post-procedural MDCT. The waist had a nearly 2-fold larger compression rate than the stent at the native annulus level (36.3 ± 10.4% vs. 18.9 ± 9.6%; p < 0.01), irrespective of valve morphologies. The supra-annulus was 5.9 ± 1.6 mm higher than the annulus on pre-procedural MDCT. Patients had an approximately 17% decrease in area from the annulus to the supra-annulus (18.3 ± 4.4% for bicuspid morphology and 16.0 ± 3.5% for tricuspid morphology)., Conclusions: Major interference between the implanted prosthesis and anatomy occurred at a level above the annulus. The decrease in area from the annulus to supra-annulus may explain the feasibility of implanting a smaller valve than that suggested by traditional annular measurements., (Copyright © 2019. Published by Elsevier Inc.)
- Published
- 2019
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6. Permanent pacemaker implantation after transcatheter aortic valve replacement in bicuspid aortic valve patients.
- Author
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Xiong TY, Liao YB, Li YJ, Zhao ZG, Wei X, Tsauo JY, Xu YN, Feng Y, and Chen M
- Subjects
- Aged, Aged, 80 and over, Aortic Valve surgery, Arrhythmias, Cardiac etiology, Bicuspid Aortic Valve Disease, Female, Humans, Incidence, Male, Multidetector Computed Tomography, Retrospective Studies, Transcatheter Aortic Valve Replacement methods, Treatment Outcome, Aortic Valve abnormalities, Arrhythmias, Cardiac surgery, Heart Valve Diseases surgery, Heart Valve Prosthesis adverse effects, Pacemaker, Artificial statistics & numerical data, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Background: Studies of permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) specifically for bicuspid aortic valve (BAV) patients are lacking. We aim to delineate possible aspects that might affect the incidence of PPI in a retrospective cohort of BAV patients treated with early-generation self-expanding devices., Methods: A total of 80 patients with bicuspid morphology who successfully underwent TAVR by self-expanding devices without prior PPI were included. Baseline clinical, echocardiographic, and angiographic characteristics, procedural and post-procedural details were collected., Results: The incidence of PPI after early-generation self-expanding valves in this BAV cohort was 26.3%. Baseline characteristics were comparable between patients requiring PPI post-TAVR or not. Perimeter oversizing greater than 20% significantly increased the risk of PPI compared with an oversizing of 10-20% (OR 5.08 [1.22, 21.07], P = 0.03). The proportion of patients with a depth of implantation greater than 6 mm was significantly higher in those who required PPI (82.4% vs 54.3%, P = 0.04). When testing the impact of depth of implantation >6 mm and oversizing in different morphologies, only in type 1 bicuspid patients and by oversizing>20% increased the risk of PPI (OR 12.00 [1.25, 115.36], P = 0.03) compared with an oversizing of 10-20%., Conclusions: Excessive perimeter oversizing in relation to aortic annulus and depth of implantation greater than 6 mm should be avoided to improve PPI post-TAVR for BAV patients receiving self-expanding devices, especially for type 1 BAV., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2018
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7. Supra-Annular Sizing for Transcatheter Aortic Valve Replacement Candidates With Bicuspid Aortic Valve.
- Author
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Xiong TY, Feng Y, Li YJ, Zhao ZG, Liao YB, Ou Y, Wei X, and Chen M
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- Aged, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve surgery, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis etiology, Aortic Valve Stenosis physiopathology, Bicuspid Aortic Valve Disease, Calcinosis diagnostic imaging, Calcinosis etiology, Calcinosis physiopathology, Feasibility Studies, Female, Heart Valve Diseases complications, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases physiopathology, Humans, Male, Recovery of Function, Treatment Outcome, Aortic Valve abnormalities, Aortic Valve pathology, Aortic Valve Stenosis surgery, Calcinosis surgery, Heart Valve Diseases surgery, Heart Valve Prosthesis, Prosthesis Design, Transcatheter Aortic Valve Replacement instrumentation
- Published
- 2018
- Full Text
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8. Imaging Evaluation for the Detection of Leaflet Thrombosis After Transcatheter Aortic Valve Replacement.
- Author
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Zhao ZG, Wang MY, and Jilaihawi H
- Subjects
- Graft Occlusion, Vascular diagnostic imaging, Graft Occlusion, Vascular pathology, Humans, Prosthesis Failure, Thrombosis diagnostic imaging, Thrombosis pathology, Time-to-Treatment, Tomography, X-Ray Computed, Aortic Valve, Heart Valve Prosthesis, Postoperative Complications etiology, Thrombosis etiology, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Subclinical leaflet thrombosis has been increasingly recognized as a common imaging finding after surgical or transcatheter aortic valve replacement (TAVR) in recent studies. This finding has raised concerns over TAVR valve durability and debates on optimal postprocedural antithrombotic regime. Hypoattenuated leaflet thickening (HALT) and the associated reduced leaflet motion (RELM) were noted as computed tomography hallmarks of the phenomenon. The coexistence of HALT and significant RELM has been suggested as a threshold for reporting of subclinical leaflet thrombosis. This methodology may contribute to the standardization of reporting for research collaboration, hence the better understanding and management of this common yet largely unknown phenomenon., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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9. Incidence, Predictors and Outcome of Prosthesis-Patient Mismatch after Transcatheter Aortic Valve Replacement: a Systematic Review and Meta-analysis.
- Author
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Liao YB, Li YJ, Jun-Li L, Zhao ZG, Wei X, Tsauo JY, Xiong TY, Xu YN, Feng Y, and Chen M
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- Heart Valve Prosthesis adverse effects, Heart Valve Prosthesis Implantation adverse effects, Humans, Incidence, Kaplan-Meier Estimate, Postoperative Complications epidemiology, Postoperative Complications etiology, Prognosis, Prosthesis Failure, Risk Factors, Transcatheter Aortic Valve Replacement adverse effects, Heart Valve Prosthesis standards, Heart Valve Prosthesis Implantation methods, Postoperative Complications diagnosis, Transcatheter Aortic Valve Replacement methods
- Abstract
The aim of this study was to investigate the incidence, predictors and outcome of prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR). A total of 30 articles incorporating 4,691 patients were identified. The pooled incidences of overall, moderate and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively. Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%, P < 0.0001) and moderate (23% vs 32%, P < 0.0001) than Edwards Sapien (ESV). PPM was associated with a younger age, smaller annulus diameter and lower left ventricular ejection fraction in comparison with those patients without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p < 0.001) during TAVR would decrease the incidence of PPM. Although PPM was common after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2 year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those without PPM. In conclusion, despite being common after TAVR, the incidence of PPM was lower than that of surgical aortic valve replacement (SAVR) and decreased with the experience accumulating, and PPM was not seen to impact on short- and mid-term survival, regardless of its magnitude.
- Published
- 2017
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10. Transcatheter aortic valve implantation with the self-expandable venus A-Valve and CoreValve devices: Preliminary Experiences in China.
- Author
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Liao YB, Zhao ZG, Wei X, Xu YN, Zuo ZL, Li YJ, Zheng MX, Feng Y, and Chen M
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- Aged, Aged, 80 and over, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Cardiac Catheterization adverse effects, Cardiac Catheterization methods, Cardiac Catheterization mortality, China, Female, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Heart Valve Prosthesis Implantation mortality, Humans, Male, Middle Aged, Prosthesis Design, Time Factors, Treatment Outcome, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Stenosis therapy, Cardiac Catheterization instrumentation, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation
- Abstract
Background: Transcatheter aortic valve implantation (TAVI) has been demonstrated to be an effective alternative to surgical aortic valve replacement (SAVR) in patients with aortic stenosis who are deemed high risk or inoperable. Currently, TAVI procedures in China mostly make use of the domestic Venus A-Valve and the CoreValve; however, there is no data on their comparative performance., Methods: Consecutive patients undergoing TAVI with the aforementioned devices were included. The outcomes were reported according to the Valve Academic Research Consortium-2 (VARC) definitions., Results: A total of 54 TAVI procedures were performed, 27 with the CoreValve and the other 27 with the Venus A-Valve. An additional valve was required in 4 (14.8%) and 3 (11.1%) patients, and the VARC-2 device success rates were 81.5 and 85.2%, respectively. The incidences of common complications were similar, except for the significantly less frequent pacemaker insertion in the Venus A-Valve group (7.4 vs. 37.0%, P = 0.03). Within 30 days, 2 (3.7%) patients died, 1 in each group, and both had a bicuspid aortic valve (BAV). No other serious complications, such as annular rupture, coronary obstruction and aortic dissection, occurred in the 32 BAV patients treated with the Venus A-Valve (14) or the CoreValve (18). After 2-years of follow-up, there was no significant difference between CoreValve group and Venus-A group (11.1 vs. 7.4%, P = 0.64)., Conclusion: TAVI with the domestic Venus A-Valve is feasible, safe, and can produce favorable short-term outcomes comparable to those with the CoreValve in inoperable or high-risk patients with tricuspid and bicuspid aortic valve stenosis. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2017
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11. Meta-Analysis of the Effectiveness and Safety of Transcatheter Aortic Valve Implantation Without Balloon Predilation.
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Liao YB, Meng Y, Zhao ZG, Zuo ZL, Li YJ, Xiong TY, Cao JY, Xu YN, Feng Y, and Chen M
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- Balloon Valvuloplasty, Humans, Prosthesis Design, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement methods
- Abstract
Evidence regarding the safety and feasibility of transcatheter aortic valve implantation without balloon predilation (BP) is scarce. A literature search of PubMed, EMBASE, CENTRAL, and major conference proceedings was performed from January 2002 to July 2015. There were 18 studies incorporating 2,443 patients included in the present study. No differences were observed in the baseline characteristics between patients without BP (no-BP) and with BP. Compared with BP, no-BP had a shorter procedure time (no-BP vs BP, 124.2 vs 138.8 minutes, p = 0.008), used less-contrast medium (no-BP vs BP, 126.3 vs 156.3 ml, p = 0.0005) and had a higher success rate (odds ratio [OR] 2.24, 95% CI 1.40 to -3.58). In addition, no-BP was associated with lower incidences of permanent pacemaker implantation (OR 0.45, 95% CI 0.3 to 0.67), grade 2 or greater paravalvular leakage (OR 0.55, 95% CI 0.37 to 0.83), and stroke (OR 0.57, 95% CI 0.32 to 1.0). Furthermore, no-BP was associated with a 0.6-fold decreased risk for 30-day all-cause mortality (OR 0.60, 95% CI 0.39 to 0.92). However, the difference in the risk for permanent pacemaker implantation, grade 2, or higher aortic regurgitation, stroke was noted to be significant only in the subgroup of the CoreValve-dominating studies. In conclusion, no-BP before transcatheter aortic valve implantation was not only safe and feasible but was also associated with fewer complications and short-term mortality in selected patients especially using self-expandable valve., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
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