**7. Conclusion**

*Advances in Complex Valvular Disease*

valve has a good therapeutic effect.

reports.

reduced (12.7% vs. 24.4%). Totally 331 AR patients underwent TAVI, with an average STS score of 6.7%. 119 cases (36%) used early valves, and 212 cases (64%) used a new generation of valvular systems. The STS score of patients with new-generation valve implantation system was lower (6.2 ± 6.7 vs. 7.6 ± 6.7), but there was no statistical difference. The new generation of valves is more likely to get through the femoral artery access (87.4% vs. 60.8%). There was no significant difference in 30-day mortality between the two groups. The 1-year all-cause mortality rates of the two groups were 24.1% and 15.6%, respectively. The 1-year all-cause mortality was related to the degree of postoperative aortic regurgitation. The mortality rate of cases with moderate and severe regurgitation was 46.1%, while mild regurgitation decreased to 21.8%. Multivariate analysis showed that more than moderate postoperative regurgitation was an independent predictor of 1-year all-cause mortality (increased by 2.85 times). And this data is not included in China's J-Valve system

In 2018, De Backer et al. [69] reported 254 high-risk AR patients in 46 centers, with an average age of 74 ± 12 years, a STS score of 6.6 ± 6.2%, with first-generation valve of 43%, and second-generation valve of 57%. The success rate of new generation valve implantation was significantly higher (82% vs. 47%), valve displacement decreased (9% vs. 33%), and aortic valve regurgitation decreased (4% vs. 31%). Both small or large valve size will easily lead to valve displacement. In 2019, Takagi et al. [70] summarized the TAVI efficacy of 11 studies with 911 pure AR patients. The overall valve implantation success rate was 80.4%, of which the early valve and the new-generation valve were 67.2% and 90.2%, respectively. Moderate and severe perivalvular leakage was 7.4% (early and new-generation valves were 17.3% and 3.4%, respectively). The 30-day all-cause mortality rate was 9.5% (early and new-generation valves were 14.7% and 6.1%, respectively). During the follow-up from 4 months to 1 year, the all-cause mortality rate was 18.8% (early and newgeneration valves were 32.2% and 11.8%, respectively). Vascular complications accounted for 3.9% (rates of early and new-generation valves were 6.2% and 3.0%, respectively). Life-threatening major bleeding was 5.7% (early and new-generation valves were 12.4% and 3.5%, respectively). In summary, the new generation of TAVI

In China, there are also surgical high-risk cases in which the ascending aorta is not wide or the left ventricular outflow tract is small; some tried to use high stent self-expanding Venus A valve to treat pure AR patients. The results show that the valve displacement rate and the chance of reimplantation of the second valve are still very high (up to more than 50%). And there is also valve displacement into the ascending aorta or slipping in the left ventricle which may affect mitral valve function. These may result in doing open-chest surgery to remove the valve immediately. Therefore, this method is only suggested to be performed for highrisk patients and when other second-generation TAVI valves like J-Valve are not

The J-Valve valve with independent intellectual property rights in China is designed with three U-shaped positioning keys suitable for the anatomical structure of the aortic valve and sinus. The valve is released in two parts and then combined to play a role, which can more accurately locate the bottom of the aortic sinus and clamp the leaflet. J-Valve can effectively play a role in both aortic stenosis and regurgitation. A multicenter clinical study of trans-apical J-Valve in the treatment of high-risk noncalcified pure AR patients concluded data from 2014 to 2018 [71] in China. A total of 82 patients, aged 73.86.3 years, were included. The score of European cardiac surgery risk assessment system was 17.5 ± 8.1%. During the TAVI operation, four patients were converted to thoracotomy due to valve transposition, and the success rate of valve implantation was 95% (78/82). During hospitalization,

**94**

available.

With the continuous development of interventional valve treatment technology, the interventional treatment of aortic stenosis and aortic insufficiency is more mature; many new generations of TAVI valves are emerging, which can be more convenient for clinicians to use, which can achieve more satisfactory treatment results. As for the development of TAVI technology and the extension of follow-up time, the indications of TAVI technology are also expanding. It is reasonable to believe that TAVI technology will be the main treatment technology in the future.
