Cardiovascular revascularization medicine : including molecular interventions · 2017
Outcomes of transcatheter aortic valve replacement using a minimalist approach.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Gurevich Sergey, Oestreich Brett, Kelly Rosemary F, Mbai Mackenzie, Bertog Stefan, Ringsred Karen, Lawton Annette, Thooft Brenda, Wagner Julie, Garcia Santiago
Аннотация
BACKGROUND: Transcatheter Aortic Valve Replacement (TAVR) is increasingly performed using a minimalist approach under monitored anesthesia care (MAC). The safety of this approach remains controversial and adoption has been low in the US.
METHODS: The study cohort was comprised of 130 patients (98% male) who underwent TAVR between 4/2015 and 4/2017 at the Minneapolis VA. We compared the outcomes of 81 patients who underwent TAVR using a standard approach (standard TAVR) and 49 who underwent TAVR using a minimalist approach (minimalist TAVR). Outcome measures included device and procedural success, procedural efficiency, length of intensive care unit (ICU) and hospital stay, procedural complications and hospital readmissions.
RESULTS: Mean age was 80 (±9) years and median (IQR) STS score was 5 (4-6). Access included transfemoral (n = 111, 85%) and alternative (n = 19, 15%). Minimalist TAVR was associated with reduced procedural time: median 101 min (IQR: 78-135) versus 127 min (IQR: 97-182, p = 0.03), fluoroscopy time: median 18 min (IQR: 12-26) versus 24 min (IQR: 16-38), p = 0.001), contrast volume 90 ml (IQR: 70-120 ml) versus 140 ml (IQR: 86-213 ml, p < 0.001).
CONCLUSIONS: A minimalistic approach to TAVR is associated with improved procedural efficiency and reduced length of stay without compromising procedural success or clinical outcomes.
METHODS: The study cohort was comprised of 130 patients (98% male) who underwent TAVR between 4/2015 and 4/2017 at the Minneapolis VA. We compared the outcomes of 81 patients who underwent TAVR using a standard approach (standard TAVR) and 49 who underwent TAVR using a minimalist approach (minimalist TAVR). Outcome measures included device and procedural success, procedural efficiency, length of intensive care unit (ICU) and hospital stay, procedural complications and hospital readmissions.
RESULTS: Mean age was 80 (±9) years and median (IQR) STS score was 5 (4-6). Access included transfemoral (n = 111, 85%) and alternative (n = 19, 15%). Minimalist TAVR was associated with reduced procedural time: median 101 min (IQR: 78-135) versus 127 min (IQR: 97-182, p = 0.03), fluoroscopy time: median 18 min (IQR: 12-26) versus 24 min (IQR: 16-38), p = 0.001), contrast volume 90 ml (IQR: 70-120 ml) versus 140 ml (IQR: 86-213 ml, p < 0.001).
CONCLUSIONS: A minimalistic approach to TAVR is associated with improved procedural efficiency and reduced length of stay without compromising procedural success or clinical outcomes.
Предметные рубрики MeSH
AgedAged, 80 and overAortic ValveAortic Valve StenosisFemaleHospital MortalityHospitals, VeteransHumansLength of StayMalePatient Care TeamPatient ReadmissionPostoperative ComplicationsProgram DevelopmentRecovery of FunctionRisk FactorsTime FactorsTranscatheter Aortic Valve ReplacementTreatment OutcomeUnited StatesWorkflow