Minimalist Transcatheter Aortic Valve Replacement Research Articles

Transcatheter Aortic Valve Replacement is Ready for Most Low-risk Patients: A Systematic Review of the Literature

Transcatheter aortic valve replacement (TAVR) has undergone rapid expansion, emerging as a viable therapeutic option for low-risk patients in lieu of surgical aortic valve replacement. This paper aims to provide a review of the scientific evidence concerning TAVR in low-risk patients, encompassing both observational and clinical trial data. Furthermore, a substantial proportion of low-risk patients possesses a bicuspid aortic valve, necessitating careful examination of the pertinent anatomic and clinical considerations to TAVR that is highlighted in this review. Additionally, the review expands upon some of the unique challenges associated with alternate access in low-risk patients evaluated for TAVR. Last, this review outlines the pivotal role of a multidisciplinary heart team approach in the execution of all TAVR procedures and the authors’ vision of ‘minimalist TAVR’ as a new era in low-risk TAVR.

Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study.

Minimalist transcatheter aortic valve replacement (TAVR) under monitored anesthesia care (MAC) emphasizes early recovery. Remimazolam is a novel benzodiazepine with a short recovery time. This study hypothesized that remimazolam is non-inferior to dexmedetomidine in terms of recovery after TAVR. In this retrospective observational study, remimazolam was compared to dexmedetomidine in patients who underwent TAVR under MAC at a tertiary academic hospital between July 2020 and July 2022. The primary outcome was timely recovery after TAVR, defined as discharge from the intensive care unit within the first day following the procedure. Propensity score matching was used to compare timely recovery between remimazolam and dexmedetomidine, applying a non-inferiority margin of -10%. The study included 464 patients, of whom 218 received remimazolam and 246 received dexmedetomidine. After propensity score matching, 164 patients in each group were included in the analysis. Regarding timely recovery after TAVR, remimazolam was non-inferior to dexmedetomidine (152 of 164 [92.7%] in the remimazolam group versus 153 of 164 [93.3%] in the dexmedetomidine group, risk difference [95% CI]: -0.6% [-6.7% to 5.5%]). The use of remimazolam was associated with fewer postoperative vasopressors/inotropes (21 of 164 [12.8%] vs. 39 of 164 [23.8%]) and temporary pacemakers (TPMs) (76 of 164 [46.3%] vs. 108 of 164 [65.9%]) compared to dexmedetomidine. In patients undergoing TAVR under MAC, remimazolam was non-inferior to dexmedetomidine in terms of timely recovery. Remimazolam may be associated with better postoperative recovery profiles, including a lesser need for vasopressors/inotropes and TPMs.

Con: General Anesthesia Should No Longer Routinely Be Used for Transfemoral Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) procedures were introduced in the early 2000s as an alternative to surgical aortic valve replacement (SAVR) in high-risk patients who were not surgical candidates. 1 Bourantas CV Serruys PW. Evolution of transcatheter aortic valve replacement. Circ Res. 2014; 114: 1037-1051 Crossref PubMed Scopus (54) Google Scholar The safety of the procedure improved over time as the procedure became more widespread and new deployment devices, valves, and percutaneous access were refined. 1 Bourantas CV Serruys PW. Evolution of transcatheter aortic valve replacement. Circ Res. 2014; 114: 1037-1051 Crossref PubMed Scopus (54) Google Scholar Encouraging outcomes, such as a decreased hospital length of stay and improved morbidity, have expanded access to TAVRs to populations deemed intermediate and low-risk for SAVR. 2 Carroll JD Mack MJ Vemulapalli S et al. STS-ACC TVT Registry of transcatheter aortic valve replacement. J Am Coll Cardiol. 2020; 76: 2492-2516 Crossref PubMed Scopus (294) Google Scholar According to the Society of Thoracic Surgery-American College of Cardiology Transcatheter Valve Therapy Registry, >70,000 TAVRs were performed in the United States in 2019, surpassing the number of SAVRs that year. 2 Carroll JD Mack MJ Vemulapalli S et al. STS-ACC TVT Registry of transcatheter aortic valve replacement. J Am Coll Cardiol. 2020; 76: 2492-2516 Crossref PubMed Scopus (294) Google Scholar The most common access site is increasingly transfemoral (95% in 2019), and the need for conversion to open cardiac surgery with the use of cardiopulmonary bypass has significantly decreased from 4% to 0.4% since the introduction of TAVRs. 2 Carroll JD Mack MJ Vemulapalli S et al. STS-ACC TVT Registry of transcatheter aortic valve replacement. J Am Coll Cardiol. 2020; 76: 2492-2516 Crossref PubMed Scopus (294) Google Scholar The focus of care surrounding TAVRs is now shifting to a minimally invasive approach with shorter procedure time, shorter hospital length of stay, and reduced costs. 3 Sawan MA Calhoun AE Grubb KJ et al. Update on minimalist TAVR care pathways: Approaches to care in 2022. Curr Cardiol Rep. 2022; 24: 1179-1187 Crossref PubMed Scopus (2) Google Scholar Although both conscious sedation and general anesthesia techniques can be used for TAVR procedures, the authors assert that conscious sedation is superior as it helps achieve these goals with potentially less risk.

Minimalist transcatheter aortic valve replacement misses paravalvular regurgitation:Incidence and echocardiographic distribution of missed paravalvular regurgitation.

Paravalvular regurgitation (PVR) may be missed intraoperatively with transthoracic echocardiography (TTE) guided minimalist TAVR. We sought to determine the incidence and echocardiographic distribution of PVR missed on intra-op TTE, but detected on predischarge TTE. From July 2015 to 2020, 475 patients with symptomatic severe native aortic stenosis underwent TTE-guided minimalist TAVR. Missed PVR was defined as predischarge PVR that was ≥1 grade higher than the corresponding intra-op PVR severity. PVR was classified as anterior or posterior on the four standard TTE views; parasternal short-axis (PSAX), parasternal long-axis (PLAX), apical 3-chamber (A3C), and 5-chamber (A5C). Location-specific risk of missed PVR was then determined. Mild or greater PVR was seen in 55 (11.5%) cases intra-op and 91 (19.1%) at predischarge, with no severe PVR. Among the 91 patients with ≥mild predischarge PVR, missed PVR was present in 42 (46.2%). Compared to the corresponding anterior jets, missed PVR rate was significantly higher for posterior jets in PLAX (62.5% vs. 25.0%, p = 0.005), A5C (56.9% vs. 25.0%, p = 0.009), PSAX (66.7% vs. 24.3%, 0.001), but not A3C (58.5% vs. 40.0%, p = 0.28). Intraoperative TTE-guided minimalist TAVR either misses nearly half of ≥mild PVR or underestimates PVR by ≥1 grade when compared to predischarge TTE. Posterior PVR jets are more likely to be missed. Transesophageal echo guidance may help minimize missing PVR. Further studies are warranted.

A Minimalist Transcatheter Aortic Valve Replacement Approach: Safety and Effectiveness in Real-World Practice.

A Minimalist Transcatheter Aortic Valve Replacement Approach: Safety and Effectiveness in Real-World Practice.

Ambulatory Electrocardiographic Monitoring Following Minimalist Transcatheter Aortic Valve Replacement

The aim of this study was to determine the impact of delayed high-degree atrioventricular block (HAVB) or complete heart block (CHB) after transcatheter aortic valve replacement (TAVR) using a minimalist approach followed by ambulatory electrocardiographic (AECG) monitoring.Little is known regarding the clinical impact of HAVB or CHB in the early period after discharge following TAVR.A prospective, multicenter study was conducted, including 459 consecutive TAVR patients without permanent pacemaker who underwent continuous AECG monitoring for 14 days (median length of hospital stay 2 days; IQR: 1-3 days), using 2 devices (CardioSTAT and Zio AT). The primary endpoint was the occurrence of HAVB or CHB. Patients were divided into 3 groups: 1) no right bundle branch block (RBBB) and no electrocardiographic (ECG) changes; 2) baseline RBBB with no further changes; and 3) new-onset ECG conduction disturbances.Delayed HAVB or CHB episodes occurred in 21 patients (4.6%) (median 5 days postprocedure; IQR: 4-6 days), leading to PPM in 17 (81.0%). HAVB or CHB events were rare in group 1 (7 of 315 [2.2%]), and the incidence increased in group 2 (5 of 38 [13.2%]; P < 0.001 vs group 1) and group 3 (9 of 106 [8.5%]; P = 0.007 vs group 1; P = 0.523 vs group 2). No episodes of sudden or all-cause death occurred at 30-day follow-up.Systematic 2-week AECG monitoring following minimalist TAVR detected HAVB and CHB episodes in about 5% of cases, with no mortality at 1 month. Whereas HAVB or CHB was rare in patients without ECG changes post-TAVR, baseline RBBB and new-onset conduction disturbances determined an increased risk. These results would support tailored management using AECG monitoring and the possibility of longer hospitalization periods in patients at higher risk for delayed HAVB or CHB.

Integration of Virtual Technologies in a Minimalist Transcatheter Aortic Valve Replacement Clinical Care Pathway

Transcatheter aortic valve replacement (TAVR) is a well-established therapy for patients with severe aortic stenosis (AS).1 In many centers, the traditional TAVR pathway has evolved to a minimalist...

Meta-analysis of minimalist versus standard care approach for transcatheter aortic valve replacement

ABSTRACT Background The change in practice of transcatheter aortic valve replacement (TAVR) to a minimalist approach is a debate. Methods Online database search for studies that compared the minimalist approach with the standard approach for TAVR were searched from inception through September 2020. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the fixed or random-effects model. Results A total of 9 studies with 2,880 TAVR patients (minimalist TAVR;1066 and standard TAVR; 1,814) were included. Compared to standard approach, there were no significant differences in in-hospital mortality, 30-day mortality, or hospital readmissions. However, there was a reduced risk of acute kidney injury (OR0.49;95%CI0.27–0.89), major bleeding (OR0.21;95%CI0.12–0.38) and major vascular complications (OR0.60,95%CI0.39–0.91) associated with the minimalist TAVR group. There was comparatively shorter hospital length of stay (mean difference −2.41;95%CI-2.99,-1.83) days, procedural time (mean difference −43.99;95%CI-67.25,-20.75) minutes, fluoroscopy time (mean difference −2.69;95%CI-3.44,-1.94) minutes and contrast volume (mean difference −26.98;95%CI-42.18,-11.79) ml in the minimalist TAVR group. Conclusions This meta-analysis demonstrated potential benefits of the minimalist TAVR approach over the standard approach regarding some adverse clinical outcomes as well as procedural outcomes without significant differences in mortality or readmission rates.

Development of the Minimalist Approach for Transcatheter Aortic Valve Replacement at a Veterans Affairs Medical Center.

While a minimalist transcatheter aortic valve replacement (TAVR) approach has shown safety and efficacy at civilian hospitals, limited data exist regarding developing this approach at Veterans Affairs (VA) medical centers (VAMCs). We implemented TAVR with minimalist approach (MA) using conscious sedation (CS) with transthoracic echocardiography (TTE) and compared safety and outcomes with general anesthesia (GA) with transesophageal echocardiography (TEE) at a university-affiliated VAMC. A total of 258 patients underwent transfemoral TAVR at a VAMC between November 2013 and October 2019. Ninety-three patients underwent GA/TEE and 165 patients underwent CS/TTE with dexmedetomidine and remifentanil. Propensity-score matching with nearest-neighbor matching was used to account for baseline differences, yielding 227 participants (81 GA, 146 CS). MA-TAVR had no effect on 30-day mortality or paravalvular leakage. No differences were found in permanent pacemaker implantation, major vascular complications, or postoperative hemodynamics. In this population, MA-TAVR did not reduce procedural time, hospital length of stay, or intensive care unit length of stay. Unlike civilian hospitals, MA with CS/TTE did not reduce overall length of stay in the veteran population; however, it was safe and effective for transfemoral TAVR without impacting clinical outcomes of mortality, major vascular complications, and paravalvular leakage.

Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era

We sought to evaluate the safety, efficacy and feasibility of same-day discharge after uncomplicated, minimalist TAVR. At the start of the COVID-19 pandemic, we created a same-day discharge (SDD) pathway after conscious sedation, transfemoral (minimalist) TAVR to help minimize risk of viral transmission and conserve hospital resources. Studies support that next-day discharge (NDD) for carefully selected patients following minimalist TAVR is safe and feasible. There is a paucity of data regarding the safety of SDD after TAVR. In-hospital and 30 day outcomes of consecutive patients meeting pre-specified criteria for SDD after minimalist TAVR at our institution between March and July of 2020 were reviewed. Outcomes were compared to a NDD cohort from July 2018 through July 2020 that would have met SDD criteria. Primary endpoints were mortality, delayed pacemaker placement, stroke and cardiovascular readmission at 30 days. Twenty nine patients were discharged via the SDD pathway after TAVR. 128 prior NDD patients were identified who met all criteria for SDD. The STS scores were similar between the two groups (SDD 2.6% ±1.5 vs. NDD 2.3% ± 1.2). There were no deaths at 30 days in either group. There was no significant difference in delayed pacemaker placement (SDD 0% vs. NDD 0.8%, p > .99) or cardiovascular readmission (SDD 0% vs. NDD 5.5%, p = .35) at 30 days. Same day discharge following uncomplicated, minimalist TAVR in selected patients appears to be safe, achieving similar 30 day outcomes as a cohort of next day discharge patients.

Very Early Changes in Quality of Life After Transcatheter Aortic Valve Replacement: Results From the 3M TAVR Trial

BackgroundPatients with severe, symptomatic aortic stenosis derive substantial 30-day quality of life (QOL) benefit from transcatheter aortic valve replacement (TAVR). Whether the QOL benefit of TAVR emerges earlier is unknown. We used data from the Multimodality, Multidisciplinary but Minimalist (3M) TAVR study to assess early changes in QOL after transfemoral (TF) TAVR. MethodsHealth status was assessed at baseline, 2-weeks, 30-days, and 1-year after TAVR using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and Medical Outcomes Study Short-Form 12 (SF-12). The KCCQ overall summary (KCCQ-OS) score (range 0–100; higher scores = better health) was the primary health status outcome. Linear mixed effects models were used to describe trajectories of QOL scores over time. A good outcome was defined as being “alive and well”, with a KCCQ-OS score ≥ 60 points with no decrease from baseline ≥10 points. ResultsA total of 358 patients (87.1%) completed the baseline and at least one follow-up survey. Between baseline and 2-weeks, the KCCQ-OS increased by 21.3 points (95% confidence interval [CI]: 19.3–23.2). This improvement was sustained over time with only slight further improvement between 2-weeks and 1-month (3.4 points; 95% CI: 1.4 to 5.5) and no significant change between 1-month and 1-year (1.9 points; 95% CI: −0.2 to 4.1). Scores for the KCCQ subscales and SF-12 physical and mental component summary scales showed a similar pattern. Most patients (74.4%) were “alive and well” at 2 weeks with similar rates at 1-month and 1-year (79.5% and 77.3%, respectively). ConclusionsAmong patients undergoing TF-TAVR, both disease-specific and generic health status improved substantially within the first 2 weeks, with only minimal further improvement thereafter.

Post-procedure protocol to facilitate next-day discharge: Results of the multidisciplinary, multimodality but minimalist TAVR study.

Evidence is lacking to standardize post-procedure care after transcatheter aortic valve replacement (TAVR). We report on the findings of the post-procedure sub-study of the multimodality, multidisciplinary but minimalist TAVR (3M TAVR) study. A standardized protocol to guide monitoring, early mobilization, reconditioning, communication, and criteria-driven discharge was implemented in a multicenter, prospective, sequential case series study in 13 North American low, medium, and high-volume centers in 2015-2017. Outcome measures pertaining to post-procedure care included avoidance of invasive lines and delirium, in-hospital bed utilization, patient disposition at the time of discharge, and 30-day use of nonelective medical services. Four hundred eleven participants were enrolled. In the post-procedure phase, 365 (88.8%) participants were admitted without a temporary pacemaker; urinary catheterization was avoided in 402 (97.8%) participants. Of note, 91.7% received care in a single unit (critical care: 72.5%; cardiac telemetry: 19.2%); 99.0% were discharged home. At the time of 30-day follow-up, 6 (1.6%) participants required admission to a rehabilitation or a skilled nursing facility; 30-day emergency department visits were 13.5%. The implementation of the 3M TAVR standardized accelerated reconditioning protocol is a safe and effective strategy to facilitate next-day discharge home after TAVR in centers of varying size.

4071Early changes in quality of life after transcatheter aortic valve replacement: One-year results from the 3M TAVR Study

Abstract Background In patients with severe calcific aortic stenosis, transcatheter aortic valve replacement (TAVR) has been shown to significantly improve quality of life (QOL). However, changes in QOL at early follow-up (&lt;1 month), and following next-day discharge are poorly understood. Methods A total of 411 patients at 13 centers were enrolled in the Multimodality, Multidisciplinary but Minimalist TAVR (3M TAVR) study in 2015–2017. QOL was evaluated using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) in participants with a baseline score and at least one score at 2 weeks, 30 days and 1 year. Study endpoints were change in (1) KCCQ-Overall Summary Score (KCCQ-OS) and (2) minimal clinically important differences (MCID). Mixed effects models were used to explore patterns of change from baseline, with fixed terms for time, status at 1-year and their interaction terms, and a random intercept for subject to account for within subject correlation. Descriptive statistics were used to report MCID. Results Data were available for 358 (87.1%) participants. 216 (60.3%) were men with a median age 84.0 and STS 5.0 There was significant increase in QOL 2 weeks after TAVR (p≤0.01), and further significant improvement at the 1-month timepoint (p&lt;0.01) for participants who were alive at 1 year. Sex, age category, and STS score category did not have a significant effect on the change in QOL (p&gt;0.05). In the first 2 weeks, moderate (10–20 points) and large (&gt;20 points) improvements were observed in 19.9% and 49.0% of the surviving patients, respectively; at 1-year, similar MCID were seen in 14.6% and 64.0% respectively. Figure 1 Conclusion This is the first study to report significant increase in QOL 2 weeks after TAVR, with sustained improvement during the first year in patients treated with the Vancouver TAVR Clinical Pathway with a goal of next-day discharge. Further studies are necessary to determine whether alternative TAVR clinical pathways yield similar findings. Acknowledgement/Funding Investigator-initiated unrestricted research grant, Edwards

Clinical and Economic Outcomes of the Minimalist Approach for Transcatheter Aortic Valve Replacement

ABSTRACT Background: To examine contemporary clinical and economic outcomes with the implementation of a minimalist program (MP) for transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis. TAVR continues to evolve with the adoption of methods intended to maximize cost-savings while maintaining clinical effectiveness, patient safety, and satisfaction. Methods: A multidisciplinary collaboration was undertaken to develop a MP for transfemoral TAVR using conscious sedation anesthesia (CS) and resource optimization. Outcomes for 107 patients treated with MP were compared to 107 univariate-matched control patients who underwent TAVR with general anesthesia (GA). Results: There were no differences between the two groups with respect to demographics, aortic stenosis severity, morbidities, symptoms, or frailty. Procedural success, major adverse complications and quality of life were also comparable. During the use of MP, there were no conversions to GA. In comparison to control patients, those who had TAVR with MP had shorter median hospital length-of-stay (LOS) (2.0 days [1.6, 2.7] vs. 3.0 days [2.0, 5.1]; p < 0.001). Implementation of MP was associated with a significant decrease in total variable costs of 17.9%, an increase in patients with a positive contribution margin (from 30% in 2015 to 65% in 2017), and cumulative cost savings of $3.6 million over 2 years. Conclusions: The implementation of a multidisciplinary minimalist TAVR program is associated with significant reductions in LOS and hospital costs, without compromising clinical outcomes or quality of life.

Safety of shorter length of hospital stay for patients undergoing minimalist transcatheter aortic valve replacement.

Determine the feasibility and predictors of early discharge after minimalist transcatheter aortic valve replacement (TAVR). Duration of hospitalization has a direct impact on overall cost of care, but the clinical impact of length of stay (LOS) in patients undergoing minimalist TAVR remains unclear. We studied 268 patients who underwent minimalist TAVR. Short LOS (sLOS) was defined as post-procedural LOS ≤ 3 days and observed in 163 patients. Prolonged LOS (pLOS) was observed in 105 patients. Propensity score matching based on 39 variables yielded 54 pairs of patients in each group. We analyzed 30-day mortality, 30-day re-hospitalization and long-term survival data. Multivariate regression models were used to define predictors of sLOS. Thirty-day mortality was 0% versus 5.5% in the sLOS and pLOS groups, respectively (P = 0.08). Incidence of re-hospitalization was higher in pLOS (13% vs. 3.7%). sLOS was associated with lower odds ratio of minor vascular complication (OR 0.1 [95% CI: 0.01, 0.75], P = 0.05), any bleeding (OR 0.35 [95% CI: 0.14, 0.87], P = 0.02), blood transfusion (OR 0.27 [95% CI: 0.08, 0.81], P = 0.02), and new pacemaker implantation (OR 0.23 [95% CI: 0.1, 0.53], P < 0.001). Discharge to home had a significantly higher odd ratio for sLOS (OR 8.67 [95% CI: 3.59, 23.11], P < 0.001). In appropriately selected patients, sLOS following minimalist TAVR approach in an experienced and high volume center is feasible and safe. Implementing such a strategy may reduce medical costs with the potential clinical benefit of early re-habilitation for the elderly TAVR population.

Outcomes of transcatheter aortic valve replacement using a minimalist approach

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. 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. 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 101min (IQR: 78-135) versus 127min (IQR: 97-182, p=0.03), fluoroscopy time: median 18min (IQR: 12-26) versus 24min (IQR: 16-38), p=0.001), contrast volume 90ml (IQR: 70-120ml) versus 140ml (IQR: 86-213ml, p<0.001). A minimalistic approach to TAVR is associated with improved procedural efficiency and reduced length of stay without compromising procedural success or clinical outcomes.

Minimalist transcatheter aortic valve replacement: The new standard for surgeons and cardiologists using transfemoral access?

BackgroundA minimalist approach for transcatheter aortic valve replacement (MA-TAVR) utilizing transfemoral access under conscious sedation and transthoracic echocardiography is increasing in popularity. This relatively novel technique may necessitate a learning period to achieve proficiency in performing a successful and safe procedure. This report evaluates our MA-TAVR cohort with specific characterization between our early, midterm, and recent experience. MethodsWe retrospectively reviewed 151 consecutive patients who underwent MA-TAVR with surgeons and interventionists equally as primary operator at Emory University between May 2012 and July 2014. Our institution had performed 300 TAVR procedures before implementation of MA-TAVR. Patient characteristics and early outcomes were compared using Valve Academic Research Consortium 2 definitions among 3 groups: group 1 included the first 50 patients, group 2 included patients 51 to 100, and group 3 included patients 101 to 151. ResultsMedian age for all patients was 84 years and similar among groups. The majority of patients were men (56%) and the median ejection fraction for all patients was 55% (interquartile range, 38.0%-60.0%). The majority of patients were high-risk surgical candidates with a median Society of Thoracic Surgeons Predicted Risk of Mortality of 10.0% and similar among groups. The overall major stroke rate was 3.3%, major vascular complications occurred in 3% of patients, and greater-than-mild paravalvular leak rate was 7%. In-hospital mortality and morbidity were similar among all 3 groups. ConclusionsIn a high-volume TAVR center, transition to MA-TAVR is feasible with acceptable outcomes and a diminutive procedural learning curve. We advocate for TAVR centers to actively pursue the minimalist technique with equal representation by cardiologists and surgeons.

SAFETY OF EARLY DISCHARGE AFTER MINIMALIST TRANSCATHETER AORTIC VALVE REPLACEMENT

Minimalist transcatheter aortic valve replacement (TAVR), performed with transfemoral access under conscious sedation guided by fluoroscopy and transthoracic echocardiogram, has a similar success rate with a lower cost and length of stay than TAVR in the operating room. We aimed to determine the