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.
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.
Authors: Molly Szerlip; Deborah Tabachnick; Mohanad Hamandi; LuAnn Caras; Allison T Lanfear; John J Squiers; Katherine Harrington; Srinivasa P Potluri; J Michael DiMaio; Jordan Wooley; Benjamin Pollock; Justin M Schaffer; William T Brinkman; David L Brown; Michael J Mack Journal: Proc (Bayl Univ Med Cent) Date: 2020-09-23
Authors: Lindsay E Bodart; Benjamin R Ciske; Jonathan Le; Nicole M Reilly; Roderick C Deaño; Steven M Ewer; Parag Tipnis; Peter S Rahko; Martin G Wagner; Amish N Raval; Michael A Speidel Journal: Med Phys Date: 2021-03-25 Impact factor: 4.071
Authors: Johannes Patzelt; Miriam Ulrich; Harry Magunia; Reinhard Sauter; Michal Droppa; Rezo Jorbenadze; Annika S Becker; Tobias Walker; Ralph Stephan von Bardeleben; Christian Grasshoff; Peter Rosenberger; Meinrad Gawaz; Peter Seizer; Harald F Langer Journal: J Am Heart Assoc Date: 2017-12-02 Impact factor: 5.501