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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.

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



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.


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.


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).


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.


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