Transaortic Transcatheter Aortic Valve Replacement in Patients From a Single Institution　― Feasibility, Safety, and Midterm Outcomes ―

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  • Kakuta Takashi
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
  • Fukushima Satsuki
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
  • Kawamoto Naonori
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
  • Kainuma Satoshi
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
  • Tadokoro Naoki
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
  • Ikuta Ayumi
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
  • Minami Kimito
    Surgical Intensive Care, National Cerebral and Cardiovascular Research Center
  • Kanzaki Hideaki
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
  • Amaki Makoto
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
  • Okada Atsushi
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
  • Irie Yuki
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
  • Takagi Kensuke
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
  • Izumi Chisato
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
  • Fujita Tomoyuki
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center

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<p>Background:Transaortic transcatheter aortic valve replacement (TAo-TAVR) is an alternative to peripheral or transapical TAVR. The procedural feasibility, safety, and midterm outcomes of TAo-TAVR were investigated in this study.</p><p>Methods and Results:Eighty-four consecutive patients underwent TAo-TAVR from 2011 to 2021. Their median age was 83 years (interquartile range, 80–87 years). The Edwards SAPIEN and Medtronic CoreValve devices were used in 45 (53.6%) and 38 (45.2%) patients, respectively. The surgical approach was a right mini-thoracotomy in 43 patients (51.2%) and partial sternotomy in 4 patients (4.8%). The remaining 37 patients (44.0%) underwent full sternotomy because of concomitant off-pump coronary artery bypass grafting. VARC-3 device success was achieved in 77 patients (91.7%). Valve migration occurred in 3 patients (3.6%) using a first-generation CoreValve device, necessitating implantation of a second valve. No aortic annulus rupture, aortic dissection, or coronary orifice occlusion occurred. Conversion to surgery was required for 1 patient because of uncontrollable bleeding. Only 1 in-hospital death occurred. New pacemaker implantation was required in 6 patients (7.1%). Echocardiography at discharge showed no or trivial paravalvular leak (PVL) in 58 patients (69.0%), mild PVL in 23 (27.4%), and mild to moderate PVL in 2 (2.4%) patients. The 1- and 3-year incidence of cardiovascular death was 1.6% and 4.8%, respectively, with no structural valve deterioration.</p><p>Conclusions:TAo-TAVR is feasible and safe with satisfactory midterm outcomes using both currently available devices.</p>

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  • Circulation Journal

    Circulation Journal 86 (3), 393-401, 2022-02-25

    一般社団法人 日本循環器学会

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