2024 expert consensus on clinical pathway for transcatheter aortic valve replacement in China_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 Structural Cardiology Committee of Cardiovascular Physicians Branch, Chinese Medical Doctor Association ,  Asia Pacific Structural Heart Disease Club

Corresponding?author：

Structural Cardiology Committee of Cardiovascular Physicians Branch, Chinese Medical Doctor Association, Email: songgy_anzhen@vip.163.com; Asia Pacific Structural Heart Disease Club, Email: peden@sina.com

Keywords：

Transcatheter aortic valve replacement; clinical evaluation; imaging assessment; standardized procedures; perioperative management; expert consensus

DOI：

10.7507/1007-4848.202410009

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We update the "2021 expert consensus on clinical pathway for transcatheter aortic valve replacement in China" using the Delphi method. By searching for evidence related to the clinical pathways of transcatheter aortic valve replacement (TAVR) in PubMed, CIKI, and Wanfang Database over the past four years, 35 core viewpoints were proposed in four directions: TAVR team composition and clinical evaluation, perioperative imaging assessment, surgical process, and perioperative and postoperative long-term management of patients. The specific updates include: refining the responsibilities and composition of the TAVR team, clarifying the steps and content of clinical evaluation; emphasizing the core position of CT in perioperative imaging assessment, and introducing the application of new technologies such as artificial intelligence, numerical simulation, and 3D printing; optimizing the TAVR surgical process, including anesthesia selection, access establishment, valve selection and release, and others; and proposing management strategies for special types of patients (such as emergency TAVR, simplified TAVR, pure aortic regurgitation, combined coronary heart disease and atrial fibrillation). In addition, the consensus also emphasizes the importance of postoperative follow-up and rehabilitation, and provides detailed antithrombotic and rehabilitation guidance. The update of this consensus will further promote the standardized development of TAVR technology in China and improve clinical treatment effects.

Citation： Structural Cardiology Committee of Cardiovascular Physicians Branch, Chinese Medical Doctor Association, Asia Pacific Structural Heart Disease Club. 2024 expert consensus on clinical pathway for transcatheter aortic valve replacement in China. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(12): 1713-1727. doi: 10.7507/1007-4848.202410009 Copy

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1. 中華醫學會心血管病學分會結構性心臟病學組, 中國醫師協會心血管內科醫師分會結構性心臟病專業委員會. 中國經導管主動脈瓣置換術臨床路徑專家共識. 中國循環雜志, 2018, 33(12): 1162-1169.Structural Heart Disease Branch, Chinese Society of Cardiology, Structural Cardiology Committee of Cardiovascular Physicians Branch, Chinese Medical Doctor Association. Expert consensus on clinical pathway for transcatheter aortic valve replacement in China. Chin Circ J, 2018, 33(12): 1162-1169.
2. 中國醫師協會心血管內科醫師分會結構性心臟病專業委員會. 中國經導管主動脈瓣置換術臨床路徑專家共識(2021版). 中國循環雜志, 2022, 37(1): 12-23.Structural Cardiology Committee of Cardiovascular Physicians Branch, Chinese Medical Doctor Association. 2021 expert consensus on clinical pathway for transcatheter aortic valve replacement in China. Chin Circ J, 2022, 37(1): 12-23.
3. Bavaria JE, Tommaso CL, Brindis RG, et al. 2018 AATS/ACC/SCAI/STS expert consensus systems of care document: Operator and institutional recommendations and requirements for transcatheter aortic valve replacement: A joint report of the American Association for Thoracic Surgery, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2019, 73(3): 340-374.
4. 中國醫師協會心血管內科醫師分會結構性心臟病專業委員會. 經導管主動脈瓣置換術中國專家共識(2020更新版). 中國介入心臟病學雜志, 2020, 28(6): 301-309.Structural Cardiology Committee of Cardiovascular Physicians Branch, Chinese Medical Doctor Association. 2020 expert consensus on transcatheter aortic valve replacement in China. Chin J Interv Cardiol, 2020, 28(6): 301-309.
5. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
6. Gertz ZM, Pibaro TP, Douglas PS, et al. Implications of left ventricular geometry in low-flow aortic stenosis: A partner 2 trial subanalysis. JACC Cardiovasc Imaging, 2019, 12(2): 367-368.
7. Sharma N, Sachedina AK, Kumar S. Low-flow, low-gradient severe aortic stenosis: A review. Heart Int, 2023, 17(1): 8-12.
8. 于子凱, 許海燕, 齊喜玲, 等. 老年綜合評估在經導管主動脈瓣置換術患者心臟康復中的應用價值. 中華老年心腦血管病雜志, 2019, 21(7): 691-694.Yu ZK, Xu HY, Qi XL, et al. Application of multidimensional geriatric assessment in cardiac rehabilitation of patients receiving transcatheter aortic valve replacement. Chin J Geriatr Heart Brain Vessel Dis, 2019, 21(7): 691-694.
9. Vahanian A, Beyersdorf F, Praz F, et al. ESC/EACTS Scientific Document Group. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

2024 expert consensus on clinical pathway for transcatheter aortic valve replacement in China

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