Minimalist transcatheter aortic valve replacement: The new standard for surgeons and cardiologists using transfemoral access? Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.

Hanna A. Jensen, Jose F. Condado, Chandan Devireddy, Jose Binongo, Bradley G. Leshnower, Vasilis Babaliaros, Eric L. Sarin, Stamatios Lerakis, Robert A. Guyton, James P. Stewart, Amjadullah Q. Syed, Kreton Mavromatis, Brian Kaebnick, Mohammad Hossein Rajaei, Lillian L. Tsai, Ayaz Rahman, Amy Simone, Patricia Keegan, Peter C. Block, Vinod H. Thourani

Research output: Contribution to journalArticlepeer-review

65 Scopus citations

Abstract

Background A minimalist approach for transcatheter aortic valve replacement (MA-TAVR) utilizing transfemoral access under conscious sedation and transthoracic echocardiography is increasing in popularity. This relatively novel technique may necessitate a learning period to achieve proficiency in performing a successful and safe procedure. This report evaluates our MA-TAVR cohort with specific characterization between our early, midterm, and recent experience. Methods We retrospectively reviewed 151 consecutive patients who underwent MA-TAVR with surgeons and interventionists equally as primary operator at Emory University between May 2012 and July 2014. Our institution had performed 300 TAVR procedures before implementation of MA-TAVR. Patient characteristics and early outcomes were compared using Valve Academic Research Consortium 2 definitions among 3 groups: group 1 included the first 50 patients, group 2 included patients 51 to 100, and group 3 included patients 101 to 151. Results Median age for all patients was 84 years and similar among groups. The majority of patients were men (56%) and the median ejection fraction for all patients was 55% (interquartile range, 38.0%-60.0%). The majority of patients were high-risk surgical candidates with a median Society of Thoracic Surgeons Predicted Risk of Mortality of 10.0% and similar among groups. The overall major stroke rate was 3.3%, major vascular complications occurred in 3% of patients, and greater-than-mild paravalvular leak rate was 7%. In-hospital mortality and morbidity were similar among all 3 groups. Conclusions In a high-volume TAVR center, transition to MA-TAVR is feasible with acceptable outcomes and a diminutive procedural learning curve. We advocate for TAVR centers to actively pursue the minimalist technique with equal representation by cardiologists and surgeons.

Original languageEnglish
Pages (from-to)833-840
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume150
Issue number4
DOIs
StatePublished - 1 Oct 2015
Externally publishedYes

Keywords

  • aortic valve
  • percutaneous
  • replacement
  • transapical

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