Korean Circ J.  2012 Oct;42(10):684-691. 10.4070/kcj.2012.42.10.684.

Transcatheter Aortic Valve Implantation: Early Experience in Korea

• Kim WJ
• Kim YH
• Lee JY
• Park DW
• Kang SJ
• Lee SW
• Lee CW
• Kim DH
• Song JM
• Kang DH
• Song JK
• Kim JB
• Jung SH
• Choo SJ
• Chung CH
• Lee JW
• Sim JY
• Choi IC
• Park SW
• Park SJ

• KMID: 1826465
• DOI: http://doi.org/10.4070/kcj.2012.42.10.684

Abstract

BACKGROUND AND OBJECTIVES
Transcatheter aortic valve implantation (TAVI) was recently introduced in Korea. The present report describes the experience of early TAVI cases.
SUBJECTS AND METHODS
Between March, 2010 and October, 2011, 48 patients with severe symptomatic aortic stenosis (AS) were screened at the Asan Medical Center to determine their suitability for surgical intervention. Of these, 23 were considered unsuitable and underwent TAVI. Procedural success rates, procedure-related complications, and clinical outcomes were evaluated in the TAVI patients.
RESULTS
Transfemoral (n=20) or transapical (n=3) TAVI was performed. The mean age of patients was 75.9+/-5.4 years and 57% were females. The mean logistic European System for Cardiac Operative Risk Evaluation was 25.6+/-5.1%. Implantation was successful in 22 patients (19 transfemoral, three transapical). After successful implantation, the mean aortic valve area increased from 0.68+/-0.14 cm2 to 1.45+/-0.33 cm2. There were no procedure-related complications or mortality. The patients showed no paravalvular aortic regurgitation with > or = moderate degree and remained stable without progression during follow-up. During follow-up (interquartile range, 1.1-12.9), all patients were alive without any occurrence of valve failure.
CONCLUSION
TAVI procedure is feasible in patients with inoperative symptomatic AS leading to hemodynamic and clinical improvement. With accumulation of experience, proper patient selection and development of device technologies, TAVI should decrease adverse events and expand the indications in the near future.

Keyword

Aortic stenosis; Valve prosthesis

MeSH Terms

Aortic Valve
Aortic Valve Insufficiency
Aortic Valve Stenosis
Female
Follow-Up Studies
Hemodynamics
Humans
Korea
Patient Selection

Figure

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  Fig. 1 Edwards prosthetic valve. An equine pericardial valve is seen within a stainless steel frame. A fabric skirt covers the bottom third of the steel. Edwards SAPIEN (A) and SAPIEN XT (B) valves.

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  Fig. 2 Annulus size measurement using echocardiography (A) and computed tomography (B, C and D). Coronal view (B); sagittal view (similar to parasternal long-axis view of echocardiography, C); double oblique view at the annulus level (D).

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  Fig. 3 Delivery systems used in tranfemoral (A and B) and transapical approach (C). A: the deflection catheter (RetroFlex-3) facilitates delivery of the prosthetic valve to the native valve. B: NovaFlex delivery system. C: ascendra transpical delivery system.

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  Fig. 4 Prosthetic valve was asymmetrically inflated in the aorta side first and spilled out to the left ventricle side (A, B and C). Successful removal of the prosthesis using the small size balloon from the left ventricle (D and E).

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  Fig. 5 Asymmetric expansion of the prosthetic valve led to embolization of the prosthesis after the procedure: fluoroscopic view (A) and computed tomography (B).

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  Fig. 6 An embolized case; computed tomography showed heavy calcific leaflets in the noncoronary cusp (A: coronal view, B: basal portion of valve, C: top of valve); aortic root angiography showed incomplete coverage of the noncoronary cusp due to heavy calcium (white arrow head, D).

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