title: Excellent outcomes for transcatheter aortic valve replacement within 1 year of opening a low-volume centre and consideration of requirements.
abstract: BACKGROUND
  After the approval of transcatheter aortic valve replacement (TAVR) for high-risk or inoperable patients with severe aortic stenosis (AS), many low- and moderate-volume TAVR programs were initiated. Contemporary outcomes from these newly initiated centres remain unknown.
  
  
  METHODS
  In March 2013, our institution was authorized by the Québec Ministry of Health to perform 30 TAVR procedures. After thorough clinical screening and imaging evaluation, suitable patients underwent transfemoral TAVR with the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, CA) transcatheter heart valve (THV). In-hospital and 30-day outcomes were prospectively collected and reported according to Valve Academic Research Consortium 2 guidelines.
  
  
  RESULTS
  From April 2013 to January 2014, 30 consecutive high-risk (n = 16 [53.3%]) or inoperable (n = 14 [46.7%]) patients (mean age, 84.6 years; mean Society of Thoracic Surgery score, 7) with symptomatic severe AS underwent transfemoral TAVR. No catastrophic intraprocedural complications such as annulus rupture, valve embolization, aortic dissection, or coronary occlusion occurred, and there were no deaths at 30 days. Disabling stroke occurred in 1 (3.3%) patient 48 hours after THV implantation. Major vascular complications and major bleeding occurred in 1 (3.3%) patient. No moderate or severe paravalvular leak was observed. The median length of stay was 2 (1-3) days, with 8 (26.7%) patients discharged within 24 hours after the procedure.
  
  
  CONCLUSIONS
  Excellent outcomes can be achieved in newly initiated relatively low-volume centres, which compares favorably to previously published large series. Important considerations include appropriate team training, rigorous patient screening, use of multimodality imaging techniques, a heart team approach, constant integration of lessons learned from larger published experiences, and maintaining a recommended minimum volume of 25 cases per year.
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Florent
authors.initials: F
authors.lastname: Chevalier
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Poulin
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
authors.forename: Yoan
authors.initials: Y
authors.lastname: Lamarche
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Van Hoai
authors.initials: VH
authors.lastname: Viet Le
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Gallant
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Anik
authors.initials: A
authors.lastname: Daoust
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Christophe
authors.initials: C
authors.lastname: Heylbroeck
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Karim
authors.initials: K
authors.lastname: Serri
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Yanick
authors.initials: Y
authors.lastname: Beaulieu
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Demers
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
authors.forename: Ismail
authors.initials: I
authors.lastname: El-Hamamsy
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
authors.forename: Hugues
authors.initials: H
authors.lastname: Jeanmart
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pagé
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Erick
authors.initials: E
authors.lastname: Schampaert
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Donald
authors.initials: D
authors.lastname: Palisaitis
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada. Electronic address: pgenereux@crf.org.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome