Open Access“Simple” Transcatheter Aortic Valve Replacement With Conscious Sedation: Safety and Effectiveness in Real-World Practice
Author(s) -
Alexander Postalian,
Neil E. Strickman,
Briana Costello,
Kathryn G. Dougherty,
Zvonimir Krajcer
Publication year - 2021
Publication title -
texas heart institute journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.373
H-Index - 53
eISSN - 1526-6702
pISSN - 0730-2347
DOI - 10.14503/thij-20-7528
Subject(s) - medicine , valve replacement , sedation , perioperative , stroke (engine) , surgery , intensive care unit , percutaneous , complication , aortic valve replacement , intensive care medicine , cardiology , stenosis , mechanical engineering , engineering
Transcatheter aortic valve replacement (TAVR) is a well-established alternative to open surgical replacement. Strictly selecting low-risk patients and using conscious sedation during TAVR has enabled hospital stays to be safely shortened. We evaluated the safety and effectiveness of a less rigorous patient-selection process involving multidisciplinary case discussions, percutaneous procedures with the use of conscious sedation, and postprocedural care outside an intensive care unit, with the goal of discharging patients from the hospital early. We call this “simple TAVR." We retrospectively reviewed the records of patients who underwent TAVR from March 2015 through February 2020 at our center. The procedures were performed by 2 high-volume operators. Of 524 total procedures, 344 (65.6%) qualified as simple TAVR. All 344 procedures were successful. The highest 30-day complication rate was associated with new permanent pacemaker implantation (7.3%, 25 patients); the rates of major vascular complications, stroke, and all-cause death were less than 3% each. Of note, 252 patients (73.3%) were discharged from the hospital the day after TAVR, and 307 (89.2%) within 48 hours. Simple TAVR is safe, economical, and feasible in real-world practice, and it does not necessitate a rigorous perioperative protocol or patient-selection process.