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Objective <p>Clinical outcomes of transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV) procedures have been reported to be poor in patients initially implanted with small bioprosthetic valves. The aim of this study was to evaluate mid-term outcomes of TAV-in-SAV for small SAVs using data from a Japanese multicenter registry.</p> Methods <p>A total of 185 TAV-in-SAV procedures performed between January 2013 and March 2024 at 10 centers in Japan were analyzed. The primary endpoint was overall 4-year Kaplan–Meier survival. Clinical outcomes were also compared between initial ≤ 21&#xa0;mm SAV (small group) vs. &gt; 21&#xa0;mm SAV (non-small group). The mean age was 82.4&#xa0;years; 46.5% were female. One hundred sixteen (62.7%) patients were in the small group (≤ 21&#xa0;mm SAV in 40 patients; &gt; 21&#xa0;mm SAV in 76 patients). The Evolut platform was used in 150 patients (81.1%), especially in the small group (103 patients, 88.8%).</p> Results <p>The 4-year survival in the small group (69.1%) was comparable to that in the non-small group (79.6%) (<i>p</i> = 0.79). Similarly, freedom from cardiovascular mortality at 4&#xa0;years in the small group (91.3%) was comparable to that in the non-small group (90.1%) (<i>p</i> = 0.096).</p> Conclusion <p>This multicenter retrospective study shows that TAV-in-SAV in Japanese patients yields satisfactory mid-term outcomes. Despite advanced age, overall and freedom from cardiovascular mortality at 4&#xa0;years were comparable to previous international reports, with no significant difference by valve size. (ClinicalTrials.gov number, NCT06826027.)</p>

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Clinical impact of initial surgical aortic bioprosthetic valve size on mid-term outcomes of transcatheter valve-in-valve in Japanese patients

  • 期刊论文

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  • 发表日期：

    2026年2月27日

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  • Koichi Maeda,
  • Satoru Domoto,
  • Kei Torikai,
  • Joji Ito,
  • Yasuhiro Ichibori,
  • Tohru Takaseya,
  • Takeshi Onohara,
  • Junji Yunoki,
  • Hiromichi Sonoda,
  • Hidenori Yoshitaka

摘要

Objective

Clinical outcomes of transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV) procedures have been reported to be poor in patients initially implanted with small bioprosthetic valves. The aim of this study was to evaluate mid-term outcomes of TAV-in-SAV for small SAVs using data from a Japanese multicenter registry.

Methods

A total of 185 TAV-in-SAV procedures performed between January 2013 and March 2024 at 10 centers in Japan were analyzed. The primary endpoint was overall 4-year Kaplan–Meier survival. Clinical outcomes were also compared between initial ≤ 21 mm SAV (small group) vs. > 21 mm SAV (non-small group). The mean age was 82.4 years; 46.5% were female. One hundred sixteen (62.7%) patients were in the small group (≤ 21 mm SAV in 40 patients; > 21 mm SAV in 76 patients). The Evolut platform was used in 150 patients (81.1%), especially in the small group (103 patients, 88.8%).

Results

The 4-year survival in the small group (69.1%) was comparable to that in the non-small group (79.6%) (p = 0.79). Similarly, freedom from cardiovascular mortality at 4 years in the small group (91.3%) was comparable to that in the non-small group (90.1%) (p = 0.096).

Conclusion

This multicenter retrospective study shows that TAV-in-SAV in Japanese patients yields satisfactory mid-term outcomes. Despite advanced age, overall and freedom from cardiovascular mortality at 4 years were comparable to previous international reports, with no significant difference by valve size. (ClinicalTrials.gov number, NCT06826027.)