• Journal of Yeungnam Medical Science
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• v.35 no.1
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• pp.17-26
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• 2018

Transcatheter aortic valve implantation (TAVI) has evolved from a challenging intervention to a standardized, simple, and streamlined procedure with over 350,000 procedures performed in over 70 countries. It is now a novel alternative to surgical aortic valve replacement in patients with intermediate surgical risk and its indications have been expanded to cohorts with bicuspid aortic valves, low surgical risk, and younger age and fewer comorbidities. Attention should be paid to further reducing remaining complications, such as paravalvular aortic regurgitation, conduction abnormalities, cardiac tamponade, and stroke. The aim of this review is to provide an overview on the rapidly changing field of TAVI treatment and to explore past achievements, current issues, and future perspectives of this treatment modality.

• Journal of Yeungnam Medical Science
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• v.41 no.2
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• pp.96-102
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• 2024

Background: The aim of this study was to compare the early outcomes of octogenarians undergoing minimally invasive right anterior mini-thoracotomy aortic valve replacement (RAT-AVR) with those undergoing transcatheter aortic valve implantation (TAVI) for aortic valve disease. Methods: In this single-center retrospective study, data were collected from octogenarians before and after RAT-AVR and TAVI between January 2021 and July 2022. Short-term outcomes, including the length of hospital stay, in-hospital mortality, all-cause mortality, and other major postoperative complications, were compared and analyzed. Results: There were no significant differences in in-hospital mortality, stroke, acute kidney dysfunction requiring renal replacement therapy, length of intensive care unit stay, or length of hospital stay. However, the TAVI group had a higher incidence of permanent pacemaker insertion (10% vs. 0%, p=0.54) and paravalvular leaks (75% vs. 0%, p<0.001). Conclusion: In the present study on octogenarians, both TAVI and RAT-AVR showed comparable short-term results. Although both procedures were considered safe and effective in the selected group, RAT-AVR had a lower incidence of complete atrioventricular block and paravalvular regurgitation.

• Journal of Chest Surgery
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• v.50 no.6
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• pp.467-470
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• 2017

Extensive mitral annulus calcifications are considered a contraindication for valve surgery. We describe the case of a 76-year-old female with severe mitral and aortic stenosis associated with extensive calcifications of the heart. The patient underwent an open mitroaortic valve replacement using transcatheter aortic valve implantation with an Edwards SAPIEN XT valve (Edwards Lifesciences Corp., Irvine, CA, USA) in the mitral position. The aortic valve was replaced using a stentless valve prosthesis (LivaNova S OLO; LivaNova PLC, London, UK). Postoperative echocardiography showed that the prosthetic valve was in the correct position and there were no paravalvular leaks. A bailout open transcatheter valve implantation can be considered a safe and effective option in selected cases with an extensively calcified mitral valve.

• Journal of Chest Surgery
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• v.46 no.5
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• pp.346-352
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• 2013

Background: Transcatheter aortic valve implantation (TAVI) has been an alternative to conventional aortic valve replacement (AVR) in old and high risk patients. The goal of this study is to compare the early outcomes of conventional AVR vs. TAVI in high risk severe AS patients. Methods: From January 2008 to July 2012, 44 high risk severe aortic stenosis patients underwent conventional AVR, and 15 patients underwent TAVI. We compared echocardiographic data, periprocedural complication, and survival. The mean follow-up duration was $14.5{\pm}10$ months (AVR), and $6.8{\pm}3.5$ months (TAVI), respectively. Results: AVR group was younger ($78.2{\pm}2.4$ years vs. $82.2{\pm}3.0$ years, p<0.001) and had lower operative risk (Euroscore: $9.4{\pm}2.7$ vs. $11.0{\pm}2.0$, p=0.044) than TAVI group. There was no significant difference in early mortality (11.4% vs. 13.3%, p=0.839), and 1 year survival ($87.4%{\pm}5.3%$ vs. $83.1%{\pm}1.1%$, p=0.805). There was no significant difference in postoperative functional class. There was no significant difference in periprocedural complication except vascular complication (0% [AVR] vs. 13.3% [TAVI], p=0.014). TAVI group had more moderate and severe paravalvular leakage. Conclusion: In this study, both groups had similar periprocedural morbidity, and mortality. However, TAVI group had more greater than moderate paravalvular leakage, which can influence long-term outcome. Since more patients are treated with TAVI even in moderate risk, careful selection of the patients and appropriate guideline need to be established.

• Korean Circulation Journal
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• v.54 no.2
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• pp.76-77
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• 2024

• Journal of Chest Surgery
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• v.51 no.5
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• pp.322-327
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• 2018

Background: This study evaluated the early and long-term outcomes of surgical aortic valve replacement (AVR) in elderly patients in the era of transcatheter aortic valve implantation. Methods: Between 2001 and 2018, 94 patients aged ${\geq}75years$ underwent isolated AVR with stented bioprosthetic valves for aortic valve stenosis (AS). The main etiologies of AS were degenerative (n=63) and bicuspid (n=21). The median follow-up duration was 40.7 months (range, 0.6-174 months). Results: Operative mortality occurred in 2 patients (2.1%) and paravalvular leak occurred in 1 patient. No patients required permanent pacemaker insertion after surgery. Late death occurred in 11 patients. The overall survival rates at 5 and 10 years were 87.2% and 65.1%, respectively. The rates of freedom from valve-related events at 5 and 10 years were 94.5% and 88.6%, respectively. The Society of Thoracic Surgeons (STS) score (p=0.013) and chronic kidney disease (p=0.030) were significant factors affecting long-term survival. The minimal p-value approach demonstrated that an STS score of 3.5% was the most suitable cut-off value for predicting long-term survival. Conclusion: Surgical AVR for elderly AS patients may be feasible in terms of early mortality and postoperative complications, particularly paravalvular leak and permanent pacemaker insertion. The STS score and chronic kidney disease were associated with long-term outcomes after AVR in the elderly.

• Journal of Yeungnam Medical Science
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• v.31 no.2
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• pp.144-147
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• 2014

Despite the necessity of surgical aortic valve replacement, many patients with symptomatic severe aortic stenosis (AS) cannot undergo surgery because of their severe comorbidities. In these high-risk patients, percutaneous transcatheter aortic valve implantation (TAVI) can be safely accomplished. However, no study has shown that TAVI can be performed for patients with severe AS accompanied by acute decompensated heart failure. In this case report, 1 patient presented a case of severe pulmonary hypertension with decompensated heart failure after diagnosis with severe AS, and was successfully treated via emergency TAVI. Without any invasive treatment, acute decompensated heart failure with severe pulmonary hypertension is common in patients with severe AS, and it can increase mortality rates. In conclusion, TAVI can be considered one of the treatment options for severe as presented as acute decompensated heart failure patients with pulmonary hypertension.

• Korean Circulation Journal
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• v.54 no.8
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• pp.515-517
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• 2024

• Journal of Chest Surgery
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• v.51 no.4
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• pp.231-240
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• 2018

Background: Analyses of the efficacy and safety of transcatheter aortic valve replacement (TAVR) in most countries have been based on outcomes obtained in accordance with national practice guidelines and monitoring protocols. The purpose of this study is to share our experience regarding the process for establishing guidelines and monitoring protocols for the use of TAVR in Korea, in the hopes that it may be helpful to others undergoing a similar process in their own country. Methods: The Korean guidelines for TAVR were established on June 1, 2015 in through a tri-party agreement involving the Department of Health and Welfare, the Korean Society of Thoracic and Cardiovascular Surgery and the Korean Society of Cardiology. We agreed to monitor the guidelines transparently and to exchange opinions regarding amendments or continuation of its contents after 3 years of monitoring. Results: The monitoring meetings were not held as regularly as agreed, and monitoring was also made difficult by insufficient and incomplete data. Nevertheless, during the meetings, measures to improve the monitoring process were discussed, and accordingly, an agreement was made to continue the monitoring process, with the aim of completing data collection by 2018. Conclusion: Compliance with guidelines is critical for assessing the efficacy and safety of TAVR. Moreover, the TAVR monitoring process must be properly conducted for an accurate evaluation to be made. Any country planning to introduce TAVR may encounter difficulties with regards to the optimal initiation strategy and subsequent monitoring. Nevertheless, continued efforts should be made to persuade the government and the corresponding medical societies to facilitate the optimal application of TAVR.

• Korean Circulation Journal
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• v.54 no.2
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• pp.63-75
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• 2024

Background and Objectives: Evidence regarding the efficacy and safety of intracardiac echocardiography (ICE) for guidance during transcatheter aortic valve replacement (TAVR) is limited. This study aimed to compare the clinical efficacy and safety of ICE versus transesophageal echocardiography (TEE) for guiding TAVR. Methods: This prospective cohort study included patients who underwent TAVR from August 18, 2015, to June 31, 2021. Eligible patients were stratified by echocardiographic modality (ICE or TEE) and anesthesia mode (monitored anesthesia care [MAC] or general anesthesia [GA]). Primary outcome was the 1-year composite of all-cause mortality, rehospitalization for cardiovascular cause, or stroke, according to the Valve Academic Research Consortium-3 (VARC-3) definition. Propensity score matching was performed, and study outcomes were analyzed for the matched cohorts. Results: Of the 359 eligible patients, 120 patients were matched for the ICE-MAC and TEEGA groups, respectively. The incidence of primary outcome was similar between matched groups (18.3% vs. 20.0%; adjusted hazard ratio, 0.94; 95% confidence interval [CI], 0.53-1.68; p=0.843). ICE-MAC and TEE-GA also had similar incidences of moderate-to-severe paravalvular regurgitation (PVR) (4.2% vs. 5.0%; adjusted odds ratio, 0.83; 95% CI, 0.23-2.82; p=0.758), new permanent pacemaker implantation, and VARC-3 types 2-4 bleeding. Conclusions: ICE was comparable to TEE for guidance during TAVR for the composite clinical efficacy outcome, with similar incidences of moderate-to-severe PVR, new permanent pacemaker implantation, and major bleeding. These results suggest that ICE could be a safe and effective alternative echocardiographic modality to TEE for guiding TAVR.