Key result
Transaortic transcatheter aortic valve replacement was feasible and safe, achieving a 91.7% VARC-3 device success rate and a 1-year cardiovascular mortality of 1.6%.
Why the study?
Transaortic transcatheter aortic valve replacement is an alternative to peripheral or transapical TAVR, but its procedural feasibility, safety, and midterm outcomes warranted investigation.
Does transaortic transcatheter aortic valve replacement provide safe and feasible outcomes in patients with aortic stenosis who are unsuitable for transfemoral access?
Cohort (n=84)
No
Does transaortic transcatheter aortic valve replacement provide safe and feasible outcomes in patients with aortic stenosis who are unsuitable for transfemoral access?
Transaortic TAVR is a feasible and safe alternative access strategy with high device success and low midterm cardiovascular mortality for patients unsuitable for transfemoral access.
Supports transaortic TAVR in transfemoral-ineligible patients; leaves open randomized comparisons to other access routes.
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. 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. CONCLUSIONS: TAo-TAVR is feasible and safe with satisfactory midterm outcomes using both currently available devices.
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A 2022 study conducted a cohort in Aortic stenosis (n=84). Transaortic Transcatheter Aortic Valve Replacement (TAo-TAVR) was evaluated on VARC-3 device success. Transaortic transcatheter aortic valve replacement was feasible and safe, achieving a 91.7% VARC-3 device success rate and a 1-year cardiovascular mortality of 1.6%.
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