title: Early experience of a transcatheter aortic valve program at a Veterans Affairs facility.
abstract: OBJECTIVE
  The US Food and Drug Administration recently approved the use of a transcatheter aortic valve in patients for whom traditional valve replacement surgery poses a high or prohibitive risk. Our hospital was one of the first Veterans Affairs facilities to launch a transcatheter aortic valve replacement (TAVR) program.
  
  
  OBJECTIVE
  To evaluate our early experience with transfemoral TAVR.
  
  
  METHODS
  We retrospectively reviewed the records of all patients who underwent TAVR during the first year of our program at the Department of Cardiothoracic Surgery, Michael E. DeBakey Veterans Affairs Medical Center.
  
  
  METHODS
  The mean (SD) age of the patients was 77 (9) years, and their mean (SD) Society of Thoracic Surgeons predicted risk of mortality score was 8.8 (10.7).
  
  
  METHODS
  All patients underwent TAVR with the SAPIEN transcutaneous valve.
  
  
  METHODS
  We evaluated operative mortality and major operative morbidity (stroke, myocardial infarction, renal failure necessitating dialysis, and requirement for mechanical circulatory support, as well as vascular complications and requirement for permanent pacemaker), in addition to length of hospital stay and discharge status.
  
  
  RESULTS
  Between December 21, 2011, and December 13, 2012, a total of 19 transfemoral TAVR procedures were performed at our center. Implantation was successful in all cases. There were no reports of operative (30-day) mortality, prosthetic valve endocarditis, renal failure necessitating dialysis, perioperative myocardial infarction or stroke, or conversion to surgical aortic valve replacement. Seven patients (37%) had mild paravalvular leak, 3 patients (16%) had moderate paravalvular leak, 2 patients (11%) had groin wound complications, 2 patients (11%) required a permanent pacemaker, 1 patient (5%) had a vascular access complication requiring endovascular repair, and 1 patient (5%) required temporary circulatory support (with extracorporeal membrane oxygenation). The mean (SD) length of hospital stay after TAVR was 8.0 (5.9) days. All patients were discharged home.
  
  
  CONCLUSIONS
  Transcatheter aortic valve replacement can be performed safely and with good outcomes at a Veterans Affairs facility with a committed multidisciplinary team and substantial experience in heart valve and endovascular therapies.
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas2Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Shuab
authors.initials: S
authors.lastname: Omer
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas3Department of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas2Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Lorraine D
authors.initials: LD
authors.lastname: Cornwell
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas3Department of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Alvin
authors.initials: A
authors.lastname: Blaustein
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas3Department of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Glen N
authors.initials: GN
authors.lastname: Levine
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas3Department of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Nadir
authors.initials: N
authors.lastname: Ali
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas3Department of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Hani
authors.initials: H
authors.lastname: Jneid
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas3Department of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Paniagua
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas4Department of Anesthesiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Prasad V
authors.initials: PV
authors.lastname: Atluri
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas5Division of Vascular Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Bechara
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas5Division of Vascular Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Panos
authors.initials: P
authors.lastname: Kougias
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Maryrose
authors.initials: M
authors.lastname: Ruma
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas6Texas Heart Institute, Houston.
authors.forename: Ourania
authors.initials: O
authors.lastname: Preventza
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas3Department of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas3Department of Cardiology, Baylor College of Medicine, Houston, Texas6Texas Heart Institute, Houston.
authors.forename: Blase A
authors.initials: BA
authors.lastname: Carabello
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas2Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas6Texas Heart Institute, Houston.
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Bakaeen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy; D006328:Cardiac Catheterization; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000379:methods*; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010348:Patient Care Team / Q000458:organization & administration*; D061214:Patient Safety; D018579:Patient Selection; D010361:Patients; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States