Evolving Paradigms in Transcatheter Aortic Valve Replacement: Results from a High-Volume, Single Center Experience

Abstract

Given the expanding indications towards younger patients at lower surgical risk, transcatheter aortic valve replacement (TAVR) simplification and streamlining is gaining increasing importance.Patients undergoing TAVR from the year 2015 to 2020 were prospectively enrolled. The patients were divided in time tertiles according to the date of intervention. Data on pre-procedural planning including coronary computed tomography angiography (CCTA), procedures, and outcomes were compared between the time tertiles. A total of 771 consecutive patients from a single institution were enrolled. We observed a trend towards the use of a fully percutaneous vs. surgical approach for the index access, left radial artery vs. contralateral femoral artery for the secondary access, and left ventricular pacing on the stiff guidewire vs. right ventricular pacing. Immediate device success significantly increased, whereas the length of hospital stay decreased. Overall, about 60% of the total study population underwent CCTA instead of coronary angiography, with no adverse events. One-year survival rates significantly improved over the time. A simplified TAVR approach was associated with better survival, whereas low baseline functional capacity, pre-existing coronary artery disease, renal impairment, peri-procedural blood transfusions, and paravalvular leak were related to worse outcomes.In conclusion, our study showed a constant tendency to procedure streamlining and to improved procedural success and one-year outcomes. A strategy based on CCTA allows sparing safely almost half of the pre-operative ICA.