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Interact Cardiovasc Thorac Surg. 2018 Mar 1;26(3):420-424. doi: 10.1093/icvts/ivx355.

Safety and efficacy of minimalist approach in transfemoral transcatheter aortic valve replacement: insights from the Optimized transCathEter vAlvular interventioN-Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry.

Author information

1
Department of cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan.
2
Department of cardiology, Toyohashi Heart Center, Toyohashi, Japan.
3
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
4
Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan.
5
Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
6
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
7
Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan.
8
Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
9
Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
10
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

Abstract

OBJECTIVES:

Favourable results have been reported for monitored anaesthesia care that includes local anaesthesia and conscious sedation [minimalist approach (MA)] for transfemoral transcatheter aortic valve replacement (TAVR). However, the efficacy of MA is still controversial in Japan. We describe our experience from a Japanese multicentre registry.

METHODS:

Between October 2013 and April 2016, 1215 consecutive Japanese patients with symptomatic, severe aortic stenosis undergoing TAVR with self-expandable or balloon-expandable valves were prospectively included in the Optimized transCathEter vAlvular intervention-Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry. Of these patients, we retrospectively reviewed 921 consecutive patients who underwent elective transfemoral-TAVR. We evaluated the perioperative results of MA-TAVR and non-minimalist approach (NMA) TAVR using propensity score matching analysis.

RESULTS:

A total of 118 patients underwent MA-TAVR, and 802 patients underwent NMA-TAVR [median age 84 vs 85 years, P = 0.25; Society of Thoracic Surgeons (STS) score 7.6 vs 6.4, P = 0.01]. One hundred eighteen matched pairs were compared after propensity score matching. In-hospital mortality and stroke/transient ischaemic attack were not significantly different between the MA-TAVR and the NMA-TAVR groups (2.5% vs 0.8%, P = 0.3; 1.7% vs 0.8%, P = 0.6, respectively). Major or life-threatening bleeding and the transfusion rate were significantly lower in the MA-TAVR group (3.4% vs 17%, P = 0.003; 6.8% vs 29%, P = 0.0002, respectively). The total intensive care unit days and length of hospital stay were significantly lower in the MA-TAVR group (P ≤ 0.0002).

CONCLUSIONS:

MA-TAVR has similar results to NMA-TAVR in terms of mortality and stroke in this Japanese multicentre registry. Shorter procedure time and hospital stays were seen in the MA-TAVR group. MA-TAVR is as safe and effective as NMA-TAVR.

PMID:
29096029
DOI:
10.1093/icvts/ivx355

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