Objective:To investigate the feasibility and clinical outcome of estimating the target length of the free margin of the leaflet by diameter of the prosthesis graft used to reconstruct the aortic root during the modified root remodeling procedure.Methods:This is a retrospective case series study. The clinical data of 11 patients with aortic root aneurysm who underwent modified aortic root remodeling procedure with external sub-valvular ring from July 2021 to May 2024 at Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College were analyzed. The age of the patients was (42.3±14.4) years (range:23 to 61 years), including 9 males and 2 females. The aortic valve of all patients was tri-leaflet configuration. Marfan syndrome was diagnosed in 3 cases. The diameter of the prosthesis graft was determined according to the Lansac group′s criteria based on the diameter of the aortic annulus, and a graft ring of the same diameter was used as the external sub-valvular ring. The free margin of the leaflet was treated with central plication according to the standard of “target length of free margin of the leaflet=the diameter of the selected graft+3 to 5 mm”. The surgical results and postoperative aortic valve closure function were observed.Results:All 11 patients successfully completed the operation without in-hospital death or complications. The graft with a diameter of 28 mm were used in 7 cases, 26 mm in 3 cases, and 30 mm in 1 case. 4 patients required central plication of the free margin of 3 leaflets, 2 patients required treatment of 2 leaflets, 3 patients required treatment of 1 leaflet, and 2 patients did not need treatment of the free margin of the leaflets. The functional status of aortic valve closure was significantly improved in all patients after surgery, and the degree of residual aortic regurgitation was not more than mild. After reconstruction of the aortic root, the measured effective height was (8.8±1.3) mm (range:7 to 11 mm) and the measured coaptation length was (5.2±0.9) mm (range:4 to 7 mm). All patients were re-examined 3 months after surgery. Echocardiography showed that the degree of aortic regurgitation was mild or lower, and the left ventricular end-diastolic diameter was (49.4±6.1) mm (range: 36 to 56 mm), which was smaller than that before the operation ((58.5±7.0) mm (range: 47 to 72 mm)). Eight patients were followed up for more than 6 months, and 5 patients were followed up for more than 1 year. The degree of aortic regurgitation in these patients was mild or below.Conclusions:The method based on the diameter of the selected prosthesis graft to deal with the length of the free margin of the leaflet can be effectively used in the modified aortic root remodeling procedure with external sub-valvular ring. The early postoperative results are satisfactory .

Objective:To investigate the feasibility and clinical outcome of estimating the target length of the free margin of the leaflet by diameter of the prosthesis graft used to reconstruct the aortic root during the modified root remodeling procedure.Methods:This is a retrospective case series study. The clinical data of 11 patients with aortic root aneurysm who underwent modified aortic root remodeling procedure with external sub-valvular ring from July 2021 to May 2024 at Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College were analyzed. The age of the patients was (42.3±14.4) years (range:23 to 61 years), including 9 males and 2 females. The aortic valve of all patients was tri-leaflet configuration. Marfan syndrome was diagnosed in 3 cases. The diameter of the prosthesis graft was determined according to the Lansac group′s criteria based on the diameter of the aortic annulus, and a graft ring of the same diameter was used as the external sub-valvular ring. The free margin of the leaflet was treated with central plication according to the standard of “target length of free margin of the leaflet=the diameter of the selected graft+3 to 5 mm”. The surgical results and postoperative aortic valve closure function were observed.Results:All 11 patients successfully completed the operation without in-hospital death or complications. The graft with a diameter of 28 mm were used in 7 cases, 26 mm in 3 cases, and 30 mm in 1 case. 4 patients required central plication of the free margin of 3 leaflets, 2 patients required treatment of 2 leaflets, 3 patients required treatment of 1 leaflet, and 2 patients did not need treatment of the free margin of the leaflets. The functional status of aortic valve closure was significantly improved in all patients after surgery, and the degree of residual aortic regurgitation was not more than mild. After reconstruction of the aortic root, the measured effective height was (8.8±1.3) mm (range:7 to 11 mm) and the measured coaptation length was (5.2±0.9) mm (range:4 to 7 mm). All patients were re-examined 3 months after surgery. Echocardiography showed that the degree of aortic regurgitation was mild or lower, and the left ventricular end-diastolic diameter was (49.4±6.1) mm (range: 36 to 56 mm), which was smaller than that before the operation ((58.5±7.0) mm (range: 47 to 72 mm)). Eight patients were followed up for more than 6 months, and 5 patients were followed up for more than 1 year. The degree of aortic regurgitation in these patients was mild or below.Conclusions:The method based on the diameter of the selected prosthesis graft to deal with the length of the free margin of the leaflet can be effectively used in the modified aortic root remodeling procedure with external sub-valvular ring. The early postoperative results are satisfactory .

Objective To explore the risk factors and potential mechanisms of hypertension events on the same day after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis. Methods Clinical data of patients who underwent TAVI for severe aortic stenosis at Department of Structural Heart Disease, Fuwai Hospital from December 2023 to February 2024 were retrospectively collected. According to the peak systolic blood pressure on the same day after surgery, patients were divided into a hypertension group (≥140 mm Hg) and a normal blood pressure group (<140 mm Hg). Logistic regression model was used to analyze the risk factors for hypertension on the same day after TAVI. Results A total of 54 patients after TAVI were included, with 41 patients in the hypertension group, including 18 males and 23 females, with an average age of (72.83±6.78) years; 13 patients in the normal blood pressure group, including 9 males and 4 females, with an average age of (70.00±7.57) years. Univariate analysis found that there were statistical differences in interventricular septal thickness [(13.71±1.98) mm vs. (12.23±1.59) mm, P=0.018], preoperative left ventricular ejection fraction (LVEF)>55% [33 (80.5%) vs. 6 (46.2%), P=0.040], and postoperative same-day LVEF>55% [33 (80.5%) vs. 4 (30.8%), P=0.003]. Multivariate logistic regression analysis found that postoperative same-day LVEF>55% [OR=10.173, 95%CI (1.044, 99.115), P=0.046] was an independent risk factor for hypertension on the same day after TAVI. Conclusion Myocardial contractility mainly participates in the occurrence of hypertension on the same day after TAVI. This study can not only improve our understanding of early hemodynamic changes after TAVI, but also provide a basis for the formulation of early hypertension treatment plans after TAVI to improve the short- and long-term prognosis of patients.

Objective    To assess outcomes of transcatheter aortic valve replacement (TAVR) for pure native aortic valve regurgitation. Methods    A total of 129 patients underwent transfemoral TAVR in Fuwai Hospital from May 2019 to October 2020 were retrospectively analyzed. There were 83 males and 46 females with an average age of 72.26±8.97 years. The patients were divided into a pure native aortic valve regurgitation group (17 patients) and an aortic valve stenosis group (112 patients). Results    The incidence of valve in valve was higher in the pure native aortic valve regurgitation group (47.0% vs. 16.1%, P<0.01). There was no statistical difference between the two groups in conversion to surgery, intraoperative use of extracorporeal circulation, intraoperative left ventricular rupture, postoperative use of extracorporeal membrane oxygenation (ECMO), peripheral vascular complications, disabled stroke, death, or pacemaker implantation. There was no statistical difference in the diameter of annulus (25.75±2.21 mm vs. 24.70±2.90 mm, P=0.068) or diameter of outflow tract (25.82±3.75 mm vs. 25.37±3.92 mm, P=0.514) between the pure native aortic valve regurgitation group and the aortic valve stenosis group. Conclusion    Transfemoral TAVR is a feasible method for patients with pure native aortic valve regurgitation. The diameter of annulus plane, the diameter of outflow tract and the shape of outflow tract should be evaluated.