Safety and efficiency of the minimalistic and precise approachfor transcatheter aortic valve implantation (TAVI) comparedto the standard one

Abstract

Since the first procedure in humans in 2002, transcatheter aortic valve implantation (TAVI) has evolved from innovative procedure of the future to treatment of choice in high-risk patients with potential to become a routine procedure in the near future. Thanks to the excellent safety profile, the emerging evidence from clinical trials, TAVI has raised its class of recommendation in the guidelines. The constantly upraising frequency of TAVI and the experience gained have led to the need of procedure improvement and standardization. Between 2013 and 2021 208 patients underwent TAVI in our cardiovascular center. The standard approach was used for 141 of them and the minimalistic and precise approach for the rest 67 patients. The main focus of this manuscript is improvement of the procedure results, quality of life and comfort of the patients, while providing a better pharmacoeconomic profile.The minimalistic and precise protocol of implantation and the vascular device closure are thoroughly described. The safety and the efficiency of the minimalistic and precise approach compared to the standard one, which is considered the ”gold standard” are proven. At the same time the minimalistic approach is described as superior to the standard one in using the radial artery as second vascular approach to reduce vascular complications and bleeding. Other advantage of the minimalistic approach is the implantation of the transcatheter aortic valve in position 0/1 while using rapid pacing, to reduce the frequency of pacemaker implantation, reduction of paravalvular leak and reduction of hospital stay. TAVI has proved to be an alternative to surgical aortic valve replacement in high risk patients and in the past years also in intermediate and low risk patients. In order TAVI to become a PCI-like procedure it must be simplified. That is exactly why the minimalistic and precise approach for TAVI is needed and it is the future of the procedure.