Outcomes of transcatheter aortic valve replacement using a minimalist approach

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.