Feasibility and Safety of Transcatheter Aortic Valve Implantation Performed Without Intensive Care Unit Admission

Leclercq, Florence; Iemmi, Anaïs; Lattuca, Benoît; Macia, Jean‐Christophe; Gervasoni, Richard; Roubille, François; Gandet, Thomas; Schmutz, Laurent; Akodad, Mariama; Agullo, Audrey; Vergés, Montserrat Palau; Nogué, Erika; Marin, Grégory; Nagot, Nicolas; Rivalland, François; Dürrleman, Nicolas; Robert, Gabriel; Delseny, Delphine; Albat, Bernard; Cayla, Guillaume

doi:10.1016/j.amjcard.2016.04.019

Cited by 20 publications

(12 citation statements)

References 30 publications

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“…In the absence of conduction disturbances or immediate vascular complications, well selected patients might recover with minimal or no time in the intensive care unit, and ambulation within 4 hours of the procedure. 71 Early (< 3 days) and next-day discharge have been shown to be feasible and safe, [72][73][74] with no increased risk of readmission within 30 days or 1 year. 75 As expected, most patients who experienced vascular or bleeding complications, or those who required insertion of a permanent pacemaker were not eligible for early discharge.…”

Section: Postprocedures Carementioning

confidence: 99%

2019 Canadian Cardiovascular Society Position Statement for Transcatheter Aortic Valve Implantation

Asgar

Ouzounian

Adams

et al. 2019

Canadian Journal of Cardiology

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Transcatheter aortic valve implantation (TAVI) or replacement has rapidly changed the treatment of patients with severe symptomatic aortic stenosis. It is now the standard of care for patients believed to be inoperable or at high surgical risk, and a reasonable alternative to surgical aortic valve replacement for those at intermediate surgical risk. Recent clinical trial data have shown the benefits of this technology in patients at low surgical risk as well. This update of the 2012 R ESUM E L'implantation valvulaire aortique par cath eter (TAVI) a rapidement modifi e le traitement des patients atteints de st enose aortique symptomatique grave. Elle constitue maintenant la norme de soins chez les patients jug es inop erables ou pr esentant un risque chirurgical elev e, de même qu'une solution de rechange raisonnable à la chirurgie de remplacement valvulaire aortique en pr esence d'un risque chirurgical interm ediaire. Les donn ees d'essais cliniques r ecents ont aussi Aortic stenosis (AS) is the most common valvular heart disease in elderly patients, with increasing prevalence worldwide. 1 Initially considered experimental, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has transitioned rapidly to the standard of care for inoperable patients with symptomatic severe AS and those at high surgical risk. 2 In 2012, the Canadian Cardiovascular Society (CCS) published its first position statement for TAVI. 3 This update is on the basis of new evidence that has become available since 2012, with the goal of providing guidance to Canadian programs in which patients with severe AS are treated and to address the unique challenges they face in terms of access to care, funding for interventions, infrastructure availability for program management and data collection, and support for patient preference in therapeutic decision-making. Methods This document was developed in accordance with CCS best practices and in accordance with the Framework for Application of Grading of Recommendations, Assessment, Development, and Evaluation (see https://www.ccs.ca/ images/Development_Process/CCS_GRADE_Framework_ June2015.pdf for details). A systematic review of the literature was performed to evaluate TAVI program considerations, patient selection, and procedural and postprocedure guidelines. The primary panel voted on all recommendations and acceptance was defined as agreement of two-thirds of the

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Section: Postprocedures Carementioning

confidence: 99%

2019 Canadian Cardiovascular Society Position Statement for Transcatheter Aortic Valve Implantation

Asgar

Ouzounian

Adams

et al. 2019

Canadian Journal of Cardiology

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show abstract

“…According to our local monitoring protocol, all patients in the TC group and high risk patients ( n = 28, 54.9%) in the TF group were monitored in ICU during at least 24 hr 14 . Non compressive carotid hematoma was the most common minor VC in the TC Group ( n = 8, 10%).…”

Section: Resultsmentioning

confidence: 99%

Transcarotid versus transfemoral access in patients undergoing transcatheter aortic valve replacement with complex aortofemoral anatomy

Leclercq

Choteau

Cayla

et al. 2020

Cathet Cardio Intervent

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Aims While major vascular complications (MVC) remains an issue after Transfemoral (TF) transcatheter aortic valve replacement (TAVR), we compared outcomes in TF versus transcarotid (TC) approaches in patients with complex vascular anatomy. Methods and results Among patients undergoing TAVR in our center between 2015 and 2018, we evaluated patients with complex vascular anatomy defined on CT scan as: (a) iliofemoral diameter between 5.5 and 6 mm or <6.5 mm with severe calcifications or tortuosity AND/OR (b) abdominal aorta pathology. The primary endpoint included access failure, mortality, MVC, major bleeding and stroke at 1‐month. Among 483 patients, 131 (31.2%) with complex vascular anatomy underwent TF (n = 51;39.2%) or TC (n = 80;60.8%) TAVR. The mean age was 81.7 ± 6.9. TC group had higher STS score (p = .01), higher incidence of coronary artery disease (p = .04) and lower left ventricular ejection fraction (p < .001). In TC group, primary endpoint occurred twice less without reaching significance compared to TF group (n = 8; 10.0% vs. n = 10; 19.6% respectively; p = .1). Incidence of MVC was higher in TF group (11.8 vs. 1.3% in the TC group; p = .01) with similar incidence of stroke between groups (p = .8). Conclusions Despite higher patient risk profile, TC approach in complex aortofemoral anatomy provides similar favorable outcomes with less MVC compared to TF approach.

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“…Patients are monitored for hemodynamic stability and cardiac rhythm for 12 to 24 hours in the ICU before transferring to the critical care unit [26]. However, ICU admission can be omitted if proper pre-and post-procedure evaluations are completed [28]. Early discharge within 24 to 48 hours can be considered as it has no difference in mortality, stroke, and readmission as compared with late discharge after 48 hours [26].…”

Section: Post-tavi Managementmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement versus Surgical Aortic Valve Replacement: A Review of Aortic Stenosis Management

Sattar

Rauf

Bareeqa

et al. 2019

Cureus

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Severe aortic stenosis (AS) affects 3.4% of the elderly over 60 years of age. It presents with exertional dyspnea, syncope, angina, and progression to irreversible congestive heart failure. Early intervention produces a better outcome in preventing the clinical deterioration of AS. The choice of intervention is transcatheter aortic valve implantation or surgical aortic valve replacement (SAVR). The decision should be made after evaluating an individual case based on its clinical features and the user's experience with transcatheter aortic valve replacement (TAVR). We reviewed available data to illustrate the types of ASs, the background of interventions, current guidelines for TAVR, and its comparison with SAVR in terms of adverse effects.

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Feasibility and Safety of Transcatheter Aortic Valve Implantation Performed Without Intensive Care Unit Admission

Cited by 20 publications

References 30 publications

2019 Canadian Cardiovascular Society Position Statement for Transcatheter Aortic Valve Implantation

2019 Canadian Cardiovascular Society Position Statement for Transcatheter Aortic Valve Implantation

Transcarotid versus transfemoral access in patients undergoing transcatheter aortic valve replacement with complex aortofemoral anatomy

Transcatheter Aortic Valve Replacement versus Surgical Aortic Valve Replacement: A Review of Aortic Stenosis Management

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