Safety and Efficacy of Transaortic Transcatheter Aortic Valve Implantation Via Right Mini-Thoracotomy

Q: What are the key findings of this study?

Transaortic TAVI via right mini-thoracotomy demonstrated similar rates of in-hospital mortality compared to transfemoral TAVI (0% vs 1.5%) in propensity-matched analysis, supporting its safety as an alternative access route for patients with unsuitable peripheral access.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Severe aortic stenosis (n=767). Intervention: Transaortic TAVI via right mini-thoracotomy (Rt-TAo) vs. Transfemoral TAVI (TF). Primary outcome: In-hospital mortality (propensity-matched cohort) (p=0.23).

Q: What does this research mean for the field?

Transaortic transcatheter aortic valve implantation via right mini-thoracotomy demonstrates comparable in-hospital mortality, periprocedural complications, and 2-year survival to the transfemoral approach in patients with unsuitable peripheral access. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Naonori Kawamoto; Kizuku Yamashita; Kota Suzuki; Takashi Kakuta; Ayumi Ikuta; Rieko Kutuzawa; Satsuki Fukushima

doi:10.1093/icvts/ivag226

August 14, 2026Interdisciplinary CardioVascular and Thoracic SurgeryOpen Access

Safety and Efficacy of Transaortic Transcatheter Aortic Valve Implantation Via Right Mini-Thoracotomy

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Key result

Transaortic TAVI via right mini-thoracotomy shows similar in-hospital mortality compared to transfemoral TAVI.

P=0.23
n=767

Figures

Graphical abstract published by Interdisciplinary CardioVascular and Thoracic Surgery — Graphical abstract · Published by Interdisciplinary CardioVascular and Thoracic Surgery · CC BY

Why the study?

Patients with unsuitable peripheral arterial anatomy require alternative transthoracic access for TAVI, and the safety and efficacy of transaortic TAVI via right mini-thoracotomy compared to transfemoral TAVI needed evaluation.

Does transaortic TAVI via right mini-thoracotomy yield comparable clinical outcomes to transfemoral TAVI in patients with severe aortic stenosis?

Key Points

To compare procedural complications and 2-year clinical outcomes between transaortic TAVI via right mini-thoracotomy and transfemoral TAVI in patients requiring aortic valve replacement.
Retrospective review of 767 consecutive patients undergoing TAVI (694 transfemoral, 73 transaortic) between January 2012 and November 2023 at a single centre.
Propensity score matching yielded 63 matched pairs to adjust for differences in baseline characteristics and Society of Thoracic Surgeons risk scores.
Primary endpoints evaluated in-hospital mortality, stroke, periprocedural morbidities, and hospital stay; secondary endpoints included 2-year survival and MACCE.
In the matched cohort (n=63 per group), transaortic TAVI had significantly higher transfusion rates (78% vs 39%, P < .0001) and longer hospital stays (15.9 ± 1.5 vs 12.9 ± 2.1 days, P = .0007), but equivalent in-hospital mortality (0% vs 1.5%, P = .23) and stroke rates (3.1% in both groups, P = 1.0).
Two-year overall survival was 85% in the transaortic group versus 91% in the transfemoral group after matching (log-rank P = .21).
Two-year freedom from MACCE after matching was 83.7% in the transaortic group versus 84% in the transfemoral group (P = .55).

Study Design

Type

Observational (n=767)

Multicenter

No

Structured PICO

Does transaortic TAVI via right mini-thoracotomy yield comparable clinical outcomes to transfemoral TAVI in patients with severe aortic stenosis?

P

Population

767 older adults (mean age 83.8, 68% female) with severe aortic stenosis undergoing transcatheter aortic valve implantation via transfemoral or right mini-thoracotomy approaches, followed for a mean of 2.1 to 2.3 years.

E

Exposure

Transaortic transcatheter aortic valve implantation via right mini-thoracotomy (Rt-TAo TAVI)

C

Comparator

Transcatheter aortic valve implantation via the transfemoral (TF) approach

O

Outcome

Rates of in-hospital mortality, stroke, and other periprocedural morbidities, and the postprocedural length of hospital stayhard clinical

Main Result

Absolute Event Rate: 0% vs 1.5%

p-value: p=0.23

Transaortic TAVI via right mini-thoracotomy is a safe and feasible alternative to transfemoral TAVI for patients with unsuitable peripheral arterial access, demonstrating comparable 2-year clinical outcomes.

Limitations

Retrospective observational study conducted at a single center, introducing potential referral bias.
Residual confounding may remain despite propensity score matching due to unmeasured variables and patient selection criteria.
Short follow-up period limits the evaluation of long-term outcomes.
Causes of death were not independently confirmed by postmortem examinations.
Retrospective observational study conducted at a single centre
Potential bias introduced by specific referral patterns
Residual confounding despite propensity score matching
Short follow-up period
Causes of death could not be independently confirmed in all cases due to lack of postmortem examinations

Implication

May support transaortic access safety in matched patients; leaves open randomized confirmation before wider adoption.

Abstract

OBJECTIVES: Transcatheter aortic valve implantation (TAVI) via the transfemoral (TF) approach is widely used. However, patients with unsuitable peripheral arterial anatomy require alternative transthoracic access. In such patients, the transaortic TAVR via right mini-thoracotomy (Rt-TAo) approach offers a less invasive option than conventional sternotomy. Therefore, this study aimed to evaluate the procedural and 2-year clinical outcomes of TF TAVI versus Rt-TAo TAVI. METHODS: Patients who underwent TAVI via the TF approach or the Rt-TAo approach between January 2012 and November 2023 were retrospectively reviewed. Baseline characteristics and clinical outcomes were compared, and propensity score matching was performed to adjust for baseline differences. The primary end-points were in-hospital mortality, stroke, other periprocedural morbidities, and postprocedural length of hospitalization. Secondary end-points included overall survival, freedom from cardiac-related death, and major adverse cardiac and cerebrovascular events (MACCE) at 2 years. RESULTS: A total of 767 consecutive patients were included in the analysis, of whom 694 underwent TF TAVI and 73 underwent Rt-TAo TAVI. Before matching, the Rt-TAo group had higher baseline prevalences of comorbidities and Society of Thoracic Surgeon risk scores. After matching, the Rt-TAo group had a longer procedural time, higher transfusion requirements, and longer lengths of intensive care unit and total hospital stays. However, the 2 groups had similar rates of periprocedural stroke, coronary obstruction, annular rupture, access-related complications, and in-hospital mortality. The 2 groups had similar 2-year rates of survival and freedom from MACCE. CONCLUSIONS: The Rt-TAo TAVI is a safe and feasible alternative for patients with unsuitable peripheral arterial access, demonstrating comparable 2-year outcomes to TF TAVI.

Discussion

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Cite This Study

Kawamoto et al. (2026) conducted an observational in Severe aortic stenosis (n=767). Transaortic TAVI via right mini-thoracotomy (Rt-TAo) vs. Transfemoral TAVI (TF) was evaluated on In-hospital mortality (propensity-matched cohort) (p=0.23). Transaortic TAVI via right mini-thoracotomy demonstrated similar rates of in-hospital mortality compared to transfemoral TAVI (0% vs 1.5%) in propensity-matched analysis, supporting its safety as an alternative access route for patients with unsuitable peripheral access.

synapsesocial.com/papers/6ad0fcb515427f6a84040258 https://doi.org/10.1093/icvts/ivag226

Topics

Transcatheter aortic valve replacement

TAVR in low-risk patients

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Safety and Efficacy of Transaortic Transcatheter Aortic Valve Implantation Via Right Mini-Thoracotomy

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Safety and Efficacy of Transaortic Transcatheter Aortic Valve Implantation Via Right Mini-Thoracotomy

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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