Simplified TAVR Procedure: How Far Is It Possible to Go?

Leclercq, Florence; Meunier, Pierre Alain; Gandet, Thomas; Macia, Jean‐Christophe; Delseny, Delphine; Gaudard, Philippe; Mourad, Marc; Schmutz, Laurent; Robert, Pierre; Roubille, François; Cayla, Guillaume; Akodad, Mariama

doi:10.3390/jcm11102793

Cited by 6 publications

(2 citation statements)

References 52 publications

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“…The care pathway for patients undergoing TAVI was initially based on open-surgery standards and often included GA, peri-procedural invasive monitoring, systematic TOE assessment, and intensive care unit (ICU) admission [ 3 ].…”

Section: The Minimalist Tavi Approachmentioning

confidence: 99%

New Practices in Transcatheter Aortic Valve Implantation: How I Do It in 2023

Tagliari

Taramasso

2023

JCM

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Transcatheter aortic valve implantation (TAVI) went through a huge evolution in the last decades. Previously performed under general anesthesia, with transoperative transesophageal echocardiography guidance and using cutdown femoral artery access, the procedure has now evolved into a minimalist approach, with local anesthesia, conscious sedation, and the avoidance of invasive lines becoming the new standards. Here, we discuss the minimalist TAVI approach and how we incorporate it into our current clinical practice.

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Section: The Minimalist Tavi Approachmentioning

confidence: 99%

New Practices in Transcatheter Aortic Valve Implantation: How I Do It in 2023

Tagliari

Taramasso

2023

JCM

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“…Currently, TAVR is recommended for treating symptomatic severe aortic stenosis (AS) regardless of the surgical risk (2)(3)(4). The feasibility of a simplified TAVR has been explored extensively and is regarded as another revolution in the development of this technique (5).…”

Section: Introductionmentioning

confidence: 99%

Single femoral artery access is safe and feasible during transcatheter aortic valve replacement: a propensity score matched analysis

Yan,

Yao,

Yuan

et al. 2023

Front. Cardiovasc. Med.

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BackgroundTranscatheter aortic valve replacement (TAVR) potentially may be significantly simplified by using the single artery access (SA) technique, which does not require a secondary artery access. Nevertheless, the safety and efficacy of this technique remains unclear. Our goal was to determine if single artery access TAVR (without upgrading the sheath size) is a feasible, minimally invasive procedure.MethodsPatients with symptomatic severe aortic stenosis who underwent TAVR via the femoral artery were consecutively enrolled in this study. Eligible individuals were divided into 2 groups: the SA group and the dual artery access (DA) group. The primary end point was device success (defined by the valve academic research consortium 3, VARC 3). A 6-month follow-up and propensity score matching analyses were performed.ResultsAfter propensity score matching analysis, a total of 130 patients were included: 65 in the SA group and 65 in the DA group. The SA procedure achieved similar device success (95.4% vs. 87.7%; P = 0.115) compared with the DA procedure. The SA procedure shortened the operating time (102 min vs. 125 min; P = 0.001) but did not increase the x-ray time or dose. Both a 20 Fr and a 22 Fr sheath (without upgrading the sheath size) could be used for the SA procedure. There was no major vascular complication occurred in both groups. The incidence of minor main vascular and access complications in the SA group was comparable to those of the DA procedure (0.0% vs. 3.1%; P = 0.156).ConclusionsThe SA access procedure is a promising minimally invasive TAVR technique with a low incidence of vascular complications and a high incidence of device success. It is safe and possibly applicable in all TAVR procedures.

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Valve unit instead of intensive or intermediate care unit admission following transcatheter edge-to-edge mitral valve repair is safe and reduces postprocedural complications

Gröger,

Felbel,

Paukovitsch

et al. 2024

Clin Res Cardiol

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Background Transcatheter edge-to-edge mitral valve repair (M-TEER) is often performed in general anesthesia, and postprocedural monitoring is usually warranted on an intensive or intermediate care unit (ICU/IMC). We evaluated the implications of a dedicated valve unit (VU) instead of an ICU/IMC for monitoring after M-TEER. Methods and results In total, 624 patients were retrospectively analyzed. A total of 312 patients were primarily transferred to either ICU or IMC following M-TEER, and 312 patients were scheduled for the VU in the absence of indications for ICU/IMC treatment. Hospital stay was significantly shorter in VU patients (median 6.0 days (interquartile range (IQR) 5.0 – 8.0) vs. 7.0 days (IQR 6.0 – 10.0), p < 0.001) and their risk for infections (2.9 vs. 7.7%, p = 0.008) and delirium (0.6 vs. 2.6%, p = 0.056) was substantially lower compared to ICU/IMC patients. In-hospital mortality was similar in both groups (0.6% vs. 1.3%, p = 0.41). Fifty patients (16.0%) in the VU group had to cross over to unplanned ICU/IMC admission. The most frequent indication was prolonged need for catecholamines (52.0%). Patients with ICU/IMC crossover had more advanced stages of heart failure (LV-EF < 30% in 36.0 vs. 16.0%, p = 0.001; severe concomitant tricuspid regurgitation in 48.0 vs. 27.8%, p = 0.005) and an LV-EF < 30% was independently associated with unplanned ICU/IMC admission. Conclusions Following M-TEER postprocedural monitoring on a VU instead of an ICU/IMC is safe, reduces complications, and spares ICU capacities. Patients with advanced heart failure have a higher risk for unplanned ICU/IMC treatment after M-TEER. Graphical abstract Valve unit instead of intensive or intermediate care unit admission following transcatheter edge-to-edge mitral valve repair is safe and reduces postprocedural complications.

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Simplified TAVR Procedure: How Far Is It Possible to Go?

Cited by 6 publications

References 52 publications

New Practices in Transcatheter Aortic Valve Implantation: How I Do It in 2023

New Practices in Transcatheter Aortic Valve Implantation: How I Do It in 2023

Single femoral artery access is safe and feasible during transcatheter aortic valve replacement: a propensity score matched analysis

Valve unit instead of intensive or intermediate care unit admission following transcatheter edge-to-edge mitral valve repair is safe and reduces postprocedural complications

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