Original title: Comparison of Transfemoral TranscatheterAortic Valve Replacement Performedin the Catheterization Laboratory(Minimalist Approach) Versus HybridOperating Room (Standard Approach). Outcomes and CostAnalysis. Reference: VasilisBabaliaros et al. J Am CollCardiolIntv 2014;7:898–904.
This retrospective study of a center analyzed the results of percutaneous aortic valve replacement (TAVR) performed with a minimally invasive technique that included the closure of the femoral access by percutaneous closure device, local anesthesia with conscious sedation and transthoracic echocardiography control compared with the standard surgical technique using femoral access, general anesthesia with endotracheal intubation and transesophageal echocardiography control.
142 patients who received elective percutaneous aortic valve replacement (minimally invasive n = 70; standard technique n = 72) were included in total. There were no differences in baseline comorbidities of the two groups (STS score 10.6 ± 4.3 vs. 11.4 ± 5.8; p = 0.35).
All procedures with minimally invasive strategy were successful although, one patient required general anesthesia and tracheal intubation. The room time (150 ± 48 min versus 218 ± 56 min, P <0.001), the time required in intensive area (22 h versus 28 h, p <0.001), total length of hospital stay until discharge (3 days versus 5 days, p <0.001) and all costs, were significantly lower with minimally invasive strategy. The 30-day mortality was similar (0% versus 6%, p = 0.12) as well as stroke rate and transient ischemic attack (4.3% versus 1.4%, p = 0.35). Moderate or severe paravalvular leak (PVL) was also similar (3% versus 5.8%, p = 0.4). At a mean follow-up of 435 days no significant difference in survival between the two strategies (minimally invasive 83% standard versus standard 82%; p = 0.639) were observed.
Conclusion
Percutaneous aortic valve replacement can be performed in a minimally invasive manner with equivalent morbidity and mortality to the standard strategy. A shorter hospital stay and reduced use of resources decrease hospital costs.
Editorial Comment
It is important to mention that the first case with minimally invasive strategy performed by the authors of this work was after 300 cases with the standard strategy. While the trend in all centers going in this direction, there is a learning curve that must be overcome.
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