title: Minimalist transcatheter aortic valve replacement: The new standard for surgeons and cardiologists using transfemoral access?
abstract: BACKGROUND
  A minimalist approach for transcatheter aortic valve replacement (MA-TAVR) utilizing transfemoral access under conscious sedation and transthoracic echocardiography is increasing in popularity. This relatively novel technique may necessitate a learning period to achieve proficiency in performing a successful and safe procedure. This report evaluates our MA-TAVR cohort with specific characterization between our early, midterm, and recent experience.
  
  
  METHODS
  We retrospectively reviewed 151 consecutive patients who underwent MA-TAVR with surgeons and interventionists equally as primary operator at Emory University between May 2012 and July 2014. Our institution had performed 300 TAVR procedures before implementation of MA-TAVR. Patient characteristics and early outcomes were compared using Valve Academic Research Consortium 2 definitions among 3 groups: group 1 included the first 50 patients, group 2 included patients 51 to 100, and group 3 included patients 101 to 151.
  
  
  RESULTS
  Median age for all patients was 84 years and similar among groups. The majority of patients were men (56%) and the median ejection fraction for all patients was 55% (interquartile range, 38.0%-60.0%). The majority of patients were high-risk surgical candidates with a median Society of Thoracic Surgeons Predicted Risk of Mortality of 10.0% and similar among groups. The overall major stroke rate was 3.3%, major vascular complications occurred in 3% of patients, and greater-than-mild paravalvular leak rate was 7%. In-hospital mortality and morbidity were similar among all 3 groups.
  
  
  CONCLUSIONS
  In a high-volume TAVR center, transition to MA-TAVR is feasible with acceptable outcomes and a diminutive procedural learning curve. We advocate for TAVR centers to actively pursue the minimalist technique with equal representation by cardiologists and surgeons.
authors: Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Hanna A
authors: HA
authors: Jensen
authors: Department of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Jose F
authors: JF
authors: Condado
authors: Department of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Chandan
authors: C
authors: Devireddy
authors: Rollins School of Public Health, Emory University, Atlanta, Ga.
authors: Jose
authors: J
authors: Binongo
authors: Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Bradley G
authors: BG
authors: Leshnower
authors: Department of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Vasilis
authors: V
authors: Babaliaros
authors: Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Eric L
authors: EL
authors: Sarin
authors: Department of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Stamatios
authors: S
authors: Lerakis
authors: Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Robert A
authors: RA
authors: Guyton
authors: Department of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: James P
authors: JP
authors: Stewart
authors: Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Amjadullah Q
authors: AQ
authors: Syed
authors: Department of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Kreton
authors: K
authors: Mavromatis
authors: Department of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Brian
authors: B
authors: Kaebnick
authors: Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Mohammad Hossein
authors: MH
authors: Rajaei
authors: Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Lillian L
authors: LL
authors: Tsai
authors: Department of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Ayaz
authors: A
authors: Rahman
authors: Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Amy
authors: A
authors: Simone
authors: Department of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Patricia
authors: P
authors: Keegan
authors: Department of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga.
authors: Peter C
authors: PC
authors: Block
authors: Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory Structural Heart and Valve Center, Emory University Hospital and Emory University Hospital Midtown, Atlanta, Ga. Electronic address: vthoura@emory.edu.
authors: Vinod H
authors: VH
authors: Thourani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D059032:Learning Curve; D008297:Male; D012189:Retrospective Studies; D013903:Thoracic Surgery / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000592:standards*
keywords: aortic valve; percutaneous; replacement; transapical