J Korean Med Sci.  2023 Dec;38(48):e404. 10.3346/jkms.2023.38.e404.

Aortic Valve Replacement in the Era of Transcatheter Aortic Valve Implantation: Current Status in Korea

• Sohn SH
• Kim KH
• Kang Y
• Choi JW
• Lee SH
• Shinn SH
• Lim C
• Sung K
• Yoo JS
• Choo SJ

• KMID: 2549167
• DOI: http://doi.org/10.3346/jkms.2023.38.e404

Abstract

Background
In the era of transcatheter aortic valve implantation, this study was conducted to investigate the current trend of aortic valve procedures in Korea and to evaluate the early and mid-term outcomes of isolated surgical aortic valve replacement (SAVR) using bioprosthetic valves in contemporary Korea.
Methods
Contemporary outcomes of isolated bioprosthetic SAVR in Korea were analyzed using the datasets on a multicenter basis. Patients who underwent isolated SAVR using bioprostheses from June 2015 to May 2019 were included, and those with concomitant cardiac procedures, SAVR with mechanical valve, or SAVR for infective endocarditis were excluded. A total of 456 patients from 4 large-volume centers were enrolled in this study. Median follow-up duration was 43.4 months. Early postoperative outcomes, mid-term clinical outcomes, and echocardiographic outcomes were evaluated.
Results
Mean age of the patients was 73.1 ± 7.3 years, and EuroSCORE II was 2.23 ± 2.09. The cardiopulmonary bypass time and aortic cross-clamp times were median 106 and 76 minutes, respectively. SAVR was performed with full median sternotomy (81.8%), right thoracotomy (14.7%), or partial sternotomy (3.5%). Operative mortality was 1.8%. The incidences of stroke and permanent pacemaker implantation were 1.1% and 1.1%, respectively. Paravalvular regurgitation ≥ mild was detected in 2.6% of the patients. Cumulative incidence of all-cause mortality at 5 years was 13.0%. Cumulative incidences of cardiovascular mortality and bioprosthetic valve dysfunction at 5 years were 7.6% and 6.8%, respectively.
Conclusion
The most recent data for isolated SAVR using bioprostheses in Korea resulted in excellent early and mid-term outcomes in a multicenter study.

Keyword

Surgical Aortic Valve Replacement; Transcatheter Aortic Valve Implantation; Bioprosthetic Valve; Outcomes

Figure

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  Fig. 1 Mid-term clinical outcomes of isolated surgical aortic valve replacement from 4 large-volume centers in Korea. Cumulative incidences of (A) all-cause mortality, (B) cardiovascular mortality, (C) bioprosthetic valve dysfunction, (D) stroke, (E) reoperation, and (F) permanent pacemaker implantation.

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  Fig. 2 Annual trend of SAVR from 2007 to 2020 in Korea.SAVR = surgical aortic valve replacement.

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  Fig. 3 Number of patients for each age subgroup classified by the type of SAVR from June 2015 to May 2020. SAVR was classified into isolated SAVR and SAVR with concomitant cardiac operations; isolated SAVR was classified into primary SAVR and redo SAVR; primary SAVR was classified into bioprosthetic SAVR and mechanical SAVR; and bioprosthetic SAVR was classified into conventional SAVR and RD/SU AVR.RD = rapid-deployment, SAVR = surgical aortic valve replacement, SU = sutureless.

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  Fig. 4 Annual trend of TAVI from 2015 to 2020 in Korea.TAVI = transcatheter aortic valve implantation.

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  Fig. 5 Number of patients in each age subgroup who received TAVI from June 2015 to May 2020.TAVI = transcatheter aortic valve implantation.

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