1. Comparison of Outcomes of Transfemoral Transcatheter Aortic Valve Implantation Using a Minimally Invasive Versus Conventional Strategy
- Author
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Chor Cheung Tam, Daniel I. Simon, Stacey Mazzurco, Angela Davis, Kehllee Popovich, David A. Zidar, Salil V. Deo, Anas Fares, Guilherme F. Attizzani, Ahmad Alkhalil, Yakov Elgudin, Ana Tomic, Alan H. Markowitz, Elizabeth Staunton, Bimal Padaliya, Basar Sareyyupoglu, Edward Avery, Hiram G. Bezerra, Joao Pedro Lopes, Sahil Parikh, Marco A. Costa, Soon J. Park, and Benjamin Medallion
- Subjects
Male ,medicine.medical_specialty ,Transcatheter aortic ,Sedation ,Conscious Sedation ,Transcatheter Aortic Valve Replacement ,Cost Savings ,Internal medicine ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Local anesthesia ,Hospital Mortality ,Survival rate ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,Significant difference ,Retrospective cohort study ,Aortic Valve Stenosis ,Length of Stay ,medicine.disease ,Surgery ,Cost savings ,Treatment Outcome ,Anesthesia ,Aortic valve stenosis ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Anesthesia, Local - Abstract
Some centers, mostly in Europe, have demonstrated the feasibility of a minimally invasive strategy (MIS; i.e., local anesthesia and conscious sedation, performed in the cath laboratory without transesophageal echocardiography guidance). Nonetheless, the experience of MIS for TAVI using both commercially available valves is lacking in the United States. We, therefore, retrospectively studied all transfemoral TAVI cases performed at our institution between March 2011 and November 2014 to assess the safety and efficacy of MIS. Patients were dichotomized according to the strategy (MIS vs conventional strategy [CS]) used for the procedure. One hundred sixteen patients were included in the MIS group and 91 patients were included in the CS group. Baseline characteristics were similar, and procedural success was comparable (99.1% in MIS and 98.9% in CS, p = 1). One intraprocedural death occurred in each group, whereas conversion rates to general anesthesia were low (3.4%). Comparable device success was obtained. Rates of complications and >mild paravalvular leak before discharge were low and comparable. Length of hospital stay was significantly reduced in the MIS (median, 3.0 [2.0 to 5.0] days) compared with than that in CS group (median 6.0 days [3.5, 8.0]). At a median follow-up of 230 days, no significant difference in survival rate was detected (89% vs 88%, p = 0.9). On average, MIS was associated with remarkable cost saving compared with CS ($16,000/case). In conclusion, TAVI through MIS was associated with a shorter postprocedural hospital stay, lower costs, and similar safety profile while keeping procedural efficacy compared with CS.
- Published
- 2015