title: Standardized methodology for transfemoral transcatheter aortic valve replacement with the Edwards Sapien XT valve under fluoroscopy guidance.
abstract: OBJECTIVE
  To provide a simplified, standardized methodology for a successful transfemoral transcatheter aortic valve replacement (TAVR) procedure with the Sapien XT valve in patients with severe aortic stenosis (AS).
  
  
  BACKGROUND
  TAVR is currently reserved for patients with severe, symptomatic AS who are inoperable or at high operative risk. In many institutions, TAVR is performed under general anesthesia with intubation or with conscious sedation. In addition, many institutions still use transesophageal echo (TEE) during the procedure for aortic root angulations and positioning of the valve prior to implantation. Methods. We enrolled 100 consecutive patients (mean age, 80 ± 7 years; range, 50-94 years; female n=59) with severe symptomatic AS. Annulus measurements were based on computed tomography angiograms. All patients underwent fluoroscopy-guided transfemoral TAVR with little to no sedation and without simultaneous TEE.
  
  
  RESULTS
  TAVR was predominantly performed with the use of local and central analgesics; only 36% of our cohort received conscious sedation. Procedural success of TAVR was 99%. Transthoracic echocardiography before discharge excluded aortic regurgitation (AR) >2 in all patients (AR >1; n=6). In-hospital stroke rate was 6%. The vessel closure system was successfully employed in 96%. Major vascular complication rate was 1%. The 30-day mortality was 2%.
  
  
  CONCLUSIONS
  Fluoroscopy-guided TAVR with the use of just analgesics with or without conscious sedation is safe and effective, and this potentially enables a more time-effective and cost-effective procedure. This paper provides simplified, stepwise guidance on how to perform transfemoral TAVR with the Sapien XT valve.
authors.affiliation: Department of Cardiovascular Disease, Deutsches Herzzentrum München, Lazarettstraße 36, 80636 Munich, Germany. amkasel1@gmail.com.
authors.forename: Albert M
authors.initials: AM
authors.lastname: Kasel
authors.forename: Anupama
authors.initials: A
authors.lastname: Shivaraju
authors.forename: Stephan
authors.initials: S
authors.lastname: Schneider
authors.forename: Stephan
authors.initials: S
authors.lastname: Krapf
authors.forename: Frank
authors.initials: F
authors.lastname: Oertel
authors.forename: Christof
authors.initials: C
authors.lastname: Burgdorf
authors.forename: Ilka
authors.initials: I
authors.lastname: Ott
authors.forename: Christian
authors.initials: C
authors.lastname: Sumer
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.forename: Wolfgang
authors.initials: W
authors.lastname: von Scheidt
authors.forename: Christian
authors.initials: C
authors.lastname: Thilo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics; D000792:Angiography; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods* / Q000592:standards; D016292:Procedural Sedation; D004452:Echocardiography; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D005471:Fluoroscopy / Q000379:methods*; D006350:Heart Valve Prosthesis / Q000145:classification*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome
chemical_list: D000700:Analgesics