Comparison of Outcomes of Transfemoral Transcatheter Aortic Valve Implantation Using a Minimally Invasive Versus Conventional Strategy

Guilherme F. Attizzani, Ahmad Alkhalil, Bimal Padaliya, Chor Cheung Tam, Joao Pedro Lopes, Anas Fares, Hiram G. Bezerra, Benjamin Medallion, Soon Park, Salil Deo, Basar Sareyyupoglu, Sahil Parikh, David Zidar, Yakov Elgudin, Kehllee Popovich, Angela Davis, Elizabeth Staunton, Ana Tomic, Stacey Mazzurco, Edward Avery & 3 others Alan Markowitz, Daniel I. Simon, Marco A. Costa

Research output: Contribution to journalArticle

21 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1731-1736
Number of pages6
JournalAmerican Journal of Cardiology
Volume116
Issue number11
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

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Length of Stay
Conscious Sedation
Safety
Costs and Cost Analysis
Transesophageal Echocardiography
Local Anesthesia
General Anesthesia
Survival Rate
Equipment and Supplies
Transcatheter Aortic Valve Replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of Outcomes of Transfemoral Transcatheter Aortic Valve Implantation Using a Minimally Invasive Versus Conventional Strategy. / Attizzani, Guilherme F.; Alkhalil, Ahmad; Padaliya, Bimal; Tam, Chor Cheung; Lopes, Joao Pedro; Fares, Anas; Bezerra, Hiram G.; Medallion, Benjamin; Park, Soon; Deo, Salil; Sareyyupoglu, Basar; Parikh, Sahil; Zidar, David; Elgudin, Yakov; Popovich, Kehllee; Davis, Angela; Staunton, Elizabeth; Tomic, Ana; Mazzurco, Stacey; Avery, Edward; Markowitz, Alan; Simon, Daniel I.; Costa, Marco A.

In: American Journal of Cardiology, Vol. 116, No. 11, 01.12.2015, p. 1731-1736.

Research output: Contribution to journalArticle

Attizzani, GF, Alkhalil, A, Padaliya, B, Tam, CC, Lopes, JP, Fares, A, Bezerra, HG, Medallion, B, Park, S, Deo, S, Sareyyupoglu, B, Parikh, S, Zidar, D, Elgudin, Y, Popovich, K, Davis, A, Staunton, E, Tomic, A, Mazzurco, S, Avery, E, Markowitz, A, Simon, DI & Costa, MA 2015, 'Comparison of Outcomes of Transfemoral Transcatheter Aortic Valve Implantation Using a Minimally Invasive Versus Conventional Strategy', American Journal of Cardiology, vol. 116, no. 11, pp. 1731-1736. https://doi.org/10.1016/j.amjcard.2015.08.044
Attizzani, Guilherme F. ; Alkhalil, Ahmad ; Padaliya, Bimal ; Tam, Chor Cheung ; Lopes, Joao Pedro ; Fares, Anas ; Bezerra, Hiram G. ; Medallion, Benjamin ; Park, Soon ; Deo, Salil ; Sareyyupoglu, Basar ; Parikh, Sahil ; Zidar, David ; Elgudin, Yakov ; Popovich, Kehllee ; Davis, Angela ; Staunton, Elizabeth ; Tomic, Ana ; Mazzurco, Stacey ; Avery, Edward ; Markowitz, Alan ; Simon, Daniel I. ; Costa, Marco A. / Comparison of Outcomes of Transfemoral Transcatheter Aortic Valve Implantation Using a Minimally Invasive Versus Conventional Strategy. In: American Journal of Cardiology. 2015 ; Vol. 116, No. 11. pp. 1731-1736.
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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.",
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AU - Alkhalil, Ahmad

AU - Padaliya, Bimal

AU - Tam, Chor Cheung

AU - Lopes, Joao Pedro

AU - Fares, Anas

AU - Bezerra, Hiram G.

AU - Medallion, Benjamin

AU - Park, Soon

AU - Deo, Salil

AU - Sareyyupoglu, Basar

AU - Parikh, Sahil

AU - Zidar, David

AU - Elgudin, Yakov

AU - Popovich, Kehllee

AU - Davis, Angela

AU - Staunton, Elizabeth

AU - Tomic, Ana

AU - Mazzurco, Stacey

AU - Avery, Edward

AU - Markowitz, Alan

AU - Simon, Daniel I.

AU - Costa, Marco A.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - 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.

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