The TATEGIRI technique: adaptation of a longitudinal aortotomy for totally endoscopic aortic valve replacement

Endoscopic aortic valve replacement (TE‑AVR) is hindered by restricted visualization and instrument maneuverability. We describe TATEGIRI (Japanese: "vertical cut"), a longitudinal aortotomy adapted for the endoscopic setting.

Between August 2023 and August 2024, 28 consecutive patients (23 sternotomies and five MICS) underwent AVR using the TATEGIRIapproach. Perioperative variables, procedural feasibility, and early outcomes were prospectively assessed.

The median cardiopulmonary bypass time was 142 min and the aortic cross-clamp time was 97 min. Valve size distribution was 19 mm in one patient (3.6%), 23 mm in eight (28.6%), 25 mm in seven (25%), 27 mm in five (17.9%), and 29 mm in one (3.6%). The mean prosthesis diameter was 24.5 ± 3.1 mm. In the five totally endoscopic cases, the median prosthesis diameter was 25 mm (interquartile range [IQR] 23-27) versus 23 mm (IQR 23-25) in full‑sternotomy cases (p = 0.09). Two patients underwent reintervention (one reexploration for bleeding and one sternal rewiring). There were two 30‑day mortalities (sepsis and stroke, both in patients who underwent sternotomy). Paravalvular leakage was not observed. The median length of the hospital stay was 13 days. Follow-up CT at a median of 3.5 months showed no aneurysmal change or stenosis and demonstrated an average 2 mm reduction in aortic diameter along the aortotomy line.

TATEGIRI longitudinal aortotomy provides consistent three-quarters (~ 270°) annular exposure while preserving a straight, fully visible suture line. Early results demonstrated technical feasibility and favorable short-term outcomes, supporting wider adoption and evaluation in comparative studies.