title: Comparison of Outcomes of Transfemoral Transcatheter Aortic Valve Implantation Using a Minimally Invasive Versus Conventional Strategy.
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.
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio. Electronic address: guilherme.attizzani@uhhospitals.org.
authors.forename: Guilherme F
authors.initials: GF
authors.lastname: Attizzani
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alkhalil
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Bimal
authors.initials: B
authors.lastname: Padaliya
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Chor-Cheung
authors.initials: CC
authors.lastname: Tam
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Joao Pedro
authors.initials: JP
authors.lastname: Lopes
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Anas
authors.initials: A
authors.lastname: Fares
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Hiram G
authors.initials: HG
authors.lastname: Bezerra
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Medallion
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Soon
authors.initials: S
authors.lastname: Park
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Salil
authors.initials: S
authors.lastname: Deo
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Basar
authors.initials: B
authors.lastname: Sareyyupoglu
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Sahil
authors.initials: S
authors.lastname: Parikh
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Zidar
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Yakov
authors.initials: Y
authors.lastname: Elgudin
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Kehllee
authors.initials: K
authors.lastname: Popovich
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Angela
authors.initials: A
authors.lastname: Davis
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Staunton
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Ana
authors.initials: A
authors.lastname: Tomic
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Stacey
authors.initials: S
authors.lastname: Mazzurco
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Edward
authors.initials: E
authors.lastname: Avery
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Alan
authors.initials: A
authors.lastname: Markowitz
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Simon
authors.affiliation: The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Costa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D016292:Procedural Sedation; D017046:Cost Savings; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome