[News] Another Successful Transapical TAVR Procedure Completed by the Cardiothoracic Surgery Team at Chinese Hospital

Recently, Professor Qin Wei and his team at Nantong University Affiliated Hospital successfully performed a transapical Transcatheter Aortic Valve Replacement (TAVR) surgery using the J-VALVE system for a patient with severe aortic valve regurgitation, effectively addressing the patient’s valve issue. Notably, the Cardiothoracic Surgery Department at Nantong University Affiliated Hospital has successfully completed seven transapical TAVR procedures in the first half of this year, demonstrating the team’s elevated expertise and ability to adeptly address diverse clinical challenges using various surgical techniques. The J-VALVE system used during the procedure showcased its ease of operation and precise positioning across different anatomical conditions, yielding highly satisfactory surgical outcomes. We look forward to more outstanding achievements from the Nantong University Affiliated Hospital Cardiothoracic Surgery Team and the J-VALVE system in the future.

Case Introduction (Male, 78 Years Old)

Chief Complaint: Recurrent shortness of breath and palpitations for 7 years.

Medical History: Seven years ago, the patient experienced chest tightness and shortness of breath without apparent cause, particularly after physical activity. Multiple treatments at other hospitals provided little relief. Recently, the patient reported worsening shortness of breath after activity, chest pain following coughing, no lower limb edema, and the ability to lie flat at night during sleep. The patient was admitted for further diagnosis and treatment.

Cardiac and Vascular Ultrasound:

• Enlarged heart and widened aorta.

• Uncoordinated ventricular wall motion.

• Significant reduction in left ventricular systolic and diastolic function.

• Reduced right ventricular systolic function.

• Aortic valve calcification with moderate-to-severe regurgitation.

• Color Doppler showing moderate-to-severe tricuspid regurgitation and mild-to-moderate mitral regurgitation.

• Moderate pulmonary hypertension.

• Minimal pericardial effusion.

  
  

Aortic CTA:

• Tricuspid aortic valve with leaflets of roughly equal size, mild leaflet thickening, and no significant calcification.

• Aortic annulus diameter approximately 29.1 mm (calculated from perimeter).

• Coronary artery ostia heights: Left Coronary Artery (LCA) 15.8 mm, Right Coronary Artery (RCA) 17.3 mm.

• Severe calcification in bilateral coronary arteries and their branches.

• Scattered calcifications observed in the visible sections of the ascending and descending aorta.

Surgical Strategy

The patient presented with aortic valve calcification accompanied by moderate-to-severe regurgitation, moderate-to-severe tricuspid regurgitation, and mild-to-moderate mitral regurgitation. Based on preoperative ultrasound and CTA results, a simulated valve implantation was performed, and a 29 mm J-VALVE was selected for the transapical TAVR procedure. The recommended intraoperative angiography angles were RAO: 2°, CAU: 22°.

Surgical Procedure

After determining the apical puncture site and establishing the working pathway, aortic root angiography was performed.

The 29 mm J-VALVE was loaded into the delivery system along a stiffened guidewire and advanced to the aortic root. Once the positioning components successfully entered the sinus, the valve was pulled down to the annular plane. Angiography confirmed optimal positioning of both the components and the valve, and the J-VALVE was gradually and stably released.

Post-release angiography showed excellent valve apposition with no significant regurgitation or paravalvular leakage.

Postoperative Outcome

Cardiac and Vascular Ultrasound:

• Post-TAVR: Bioprosthetic aortic valve in place, functioning normally, with a stable valve frame position.

• Slightly enlarged left atrium and left ventricle, widened aortic sinus.

• Reduced left ventricular systolic and diastolic function.

• Color Doppler showing mild tricuspid regurgitation.

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Expert Profile

Qin Wei

Nantong University Affiliated Hospital

Director of Cardiothoracic Surgery, Chief Physician, Master’s Degree Advisor, Associate Professor, Doctor of Clinical Medicine

With 15 years of experience in a national clinical key specialty, Dr. Qin specializes in aortic aneurysms, aortic dissections, heart valve diseases, coronary heart disease, and surgical treatment of atrial fibrillation. He has extensive clinical expertise in the surgical management of aortic dissections and has published over 30 related papers. Dr. Qin has received the Jiangsu Medical Science and Technology Award, the Nanjing New Technology Introduction Award, and various awards in paper and surgical competitions from the Chinese Medical Association and Jiangsu Medical Association.

Since 2018, he has performed aortic dissection surgery demonstrations at multiple tertiary hospitals across Jiangsu, innovating artificial vascular anastomosis techniques. His papers have been published in prestigious cardiovascular surgery journals, including JTCVS Techniques, J Card Surg, J Cardiothorac Surg, Chin Med J (Engl), Perfusion, Front Surg, and Chinese Journal of Thoracic and Cardiovascular Surgery. He has been invited to speak at numerous international and domestic academic conferences. From October to December 2017, he trained at the McLeod Heart Center in the United States, and from September to December 2024, he was sponsored to study minimally invasive cardiac surgery in Germany. Currently, Dr. Qin serves as a member of the Jiangsu Medical Association’s Organ Transplantation Branch, the Large Vessel Group of the Jiangsu Medical Association’s Cardiovascular Surgery Branch, a standing committee member of the Jiangsu Structural Heart Disease Committee, a youth committee member of the National Cardiovascular Disease Expert Committee’s Minimally Invasive Cardiovascular Surgery Branch, and a youth editorial board member of the Journal of Chinese Cardiovascular Research.

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