From 2018 to 2020, four patients with aortic valve disease in the First People's Hospital of Yunnan Province underwent transcatheter aortic valve implantation (TAVI). Three of the patients had severe aortic stenosis, and one patient had severe aortic regurgitation. The valve-in-valve method was used for the patient with severe aortic regurgitation. The operations for all 4 patients went smoothly and they were able to mobilize out of bed 10 hours after surgery. Five days postoperatively, all relevant indicators were satisfactory and they were able to be discharged. All patients had no discomfort on follow-up up to October 2020. It can be seen from these four patients that TAVI surgery is highly recommended for patients with aortic stenosis or other eligible dysfunctions which are assessed to be a risk for older patients, and the transfemoral approach is preferred.

1.Vahl TP, Kodali SK, Leon MB. Transcatheter aortic valve replacement 2016: a modern-day "Through the Looking-Glass" adventure[J]. J Am Coll Cardiol, 2016, 67(12): 1472-1487. DOI: 10.1016/j.jacc.2015.12.059.

2.Kappetein AP, Head SJ, Genereux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the valve academic research consortium-2 consensus document[J]. J Am Coll Cardiol, 2012, 60(15): 1438-1454. DOI: 10.1016/j.jacc.2012.09. 001.

3.Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)[J]. Eur J Cardiothorac Surg, 2012, 42(4): S1-44. DOI: 10.1093/ejcts/ezs455.

4.Omran H, Schmidt H, Hackenbroch M, et al. Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study[J]. Lancet, 2003, 361(9365): 1241-1246. DOI: 10.1016/S0140-6736(03)12978-9.

5.Dumesnil JG, Pibarot P, Carabello B. Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implications for diagnosis and treatment[J]. Eur Heart J, 2010, 31(3): 281-289. DOI: 10.1093/eurheartj/ehp361.

6.Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients[J]. N Engl J Med, 2016, 374(17): 1609-1620. DOI: 10.1056/NEJMoa1514616.

7.Edwards FH, Cohen DJ, O'Brien SM, et al. Development and validation of a risk prediction model for in-hospital mortality after transcatheter aortic valve replacement[J]. JAMA Cardiol, 2016, 1(1): 46-52. DOI: 10.1001/jama cardio.2015.0326.

8.Pilgrim T, Franzone A, Stortecky S, et al. Predicting mortality after transcatheter aortic valve replacement: external validation of the transcatheter valve therapy registry model[J]. Circ Cardiovasc Interv, 2017, 10(11): e005481. DOI: 10.1161/CIRCINTERVENTIONS.117. 005481.

9.Schoenenberger AW, Stortecky S, Neumann S, et al. Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI)[J]. Eur Heart J, 2013, 34(9): 684-692. DOI: 10.1093/eurheartj/ehs304.

10.Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the society of cardiovascular anesthesiologists endorsed by the society for cardiovascular angiography and interventions and the society of thoracic surgeons[J]. J Am Coll Cardiol, 2006, 48(3): e1-148. DOI: 10.1016/j.jacc.2006.05.021.

11.Möllmann H, Husser O, Blumenstein J，et al. Lower mortality in an all-comers aortic stenosis population treated with TAVI in comparison to SAVR[J]. Clinical Research in Cardiology, 2020, 109(5): 611-615. DOI: 10.1007/s00392-019-01548-1.

12.Popma J, Deeb G, Yakubov S, et al. Transcatheteraortic-valve replacement with a self-expanding valve in low-risk patients[J]. N Engl J Med, 2019, 380(18): 1706-1715. DOI: 10.1056/NEJMoa1816885.

13.Gaede L, Blumenstein J, Liebetrau C, et al. Outcome after transvascular transcatheter aortic valve implantation in 2016[J]. Eur Heart J, 2018, 39(8): 667-675. DOI: 10.1093/eurheartj/ehx688.

14.Gaede L, Blumenstein J, Liebetrau C, et al. Transvascular transcatheter aortic valve implantation in 2017[J]. Clin Res Cardiol, 2020, 109(3): 303-314. DOI: 10.1007/s00392-019-01509-8.

15.Bekeredjian R, Szabo G, Balaban Ü, et al. Patients at low surgical risk as defined by the society of thoracic surgeons score undergoing isolated interventional or surgical aortic valve implantation: in-hospital data and 1-year results from the German Aortic Valve Registry (GARY)[J]. Eur Heart J, 2019, 40(17): 1323-1330. DOI: 10.1093/eurheartj/ehy699.

16.Kim WK, Hamm CW. Transcatheter aortic valve implantation in Germany[J]. Clin Res Cardiol, 2018, 107(2): 81-87. DOI: 10.1007/s00392-018-1297-0.

17.Kim WK, Blumenstein J, Liebetrau C, et al. Comparison of outcomes using balloon-expandable versus self-expanding transcatheter prostheses according to the extent of aortic valve calcification[J]. Clin Res Cardiol, 2017, 106(12): 995-1004. DOI: 10.1007/s00392-017-1149-3.

18.Gaede L, Blumenstein J, Kim W-K, et al. Trends in aortic valve replacement in Germany in 2015: transcatheter versus isolated surgical aortic valve repair[J]. Clin Res Cardiol, 2017, 106(6): 411-419. DOI: 10.1007/s00392-016-1070-1.

19.Gaede L, Kim WK, Liebetrau C, et al. Pacemaker implantation after TAVI: predictors of AV block persistence[J]. Clin Res Cardiol, 2018, 107(1): 60-69. DOI: 10.1007/s00392-017-1158-2.

20.Sergi D, Acconcia MC, Muscoli S, et al. Meta-analysis of the impact on early and late mortality of TAVI compared to surgical aortic valve replacement in high and low-intermediate surgical risk patients[J]. Eur Rev Med Pharmacol Sci, 2019, 23(12): 5402-5412. DOI: 10.26355/eurrev_201906_18209.

21.Mack MJ, Holmes DR, Webb J, et al. Patient selection for transcatheter aortic valve replacement[J]. J Am Coll Cardiol, 2013, 62(17): S1-10. DOI: 10.1016/j.jacc.2013. 08.707.

22.Petronio AS, Capranzano P, Barbato E, et al. Current status of transcatheter valve therapy in Europe: results from an EAPCI survey[J]. Euro Intervention, 2016, 12(7): 890-895. DOI: 10.4244/EIJY16M06_01.

23.Popma J, Deeb G, Yakubov S, et al. Transcatheteraortic-valve replacement with a self-expanding valve in low-risk patients[J]. N Engl J Med, 2019, 380(18): 1706-1715. DOI: 10.1056/NEJMoa1816885.

24.Gaede L, Blumenstein J, Liebetrau C, et al. Outcome after transvascular transcatheter aortic valve implantation in 2016[J]. Eur Heart J, 2018, 39(8): 667-675. DOI: 10.1093/eurheartj/ehx688. 

25.Gaede L, Blumenstein J, Liebetrau C, et al. Transvascular transcatheter aortic valve implantation in 2017[J]. Clin Res Cardiol, 2020, 109(3): 303-314. DOI: 10.1007/s00392-019-01509-8.