Clinical ResearchExcellent Outcomes for Transcatheter Aortic Valve Replacement Within 1 Year of Opening a Low-Volume Centre and Consideration of Requirements
Section snippets
Patient population
In March 2013, the Ministry of Health authorized our institution to perform TAVR procedures in patients with severe AS who were unsuitable for surgical aortic valve replacement (SAVR). All patients underwent extensive screening, including simultaneous clinical evaluation by a cardiologist, cardiothoracic surgeon, and dedicated nurse in a specialized TAVR clinic. Multimodality imaging assessment was performed in all patients, including transthoracic echocardiography, transesophageal
Definitions
All outcomes were adjudicated according to the standardized Valve Academic Research Consortium 2 (VARC-2) guidelines20 by 2 cardiologists. Clinical data were collected prospectively from systematic follow-up of all patients. Echocardiographic evaluation was performed by 2 experienced cardiologists in accordance with published guidelines from the American Society of Echocardiography.21, 22
Paravalvular leak (PVL) was defined according to VARC-2 recommendations.20 When available, the density of
Patient population
Between April 2013 and January 2014, 30 consecutive patients underwent TF-TAVR. Baseline characteristics are shown in Table 1. The mean age was 84.6 ± 4.0 years, with a mean Society of Thoracic Surgery score of 7.0% ± 3.5%. Fourteen (46.7%) patients were deemed inoperable (ie, porcelain aorta) and 16 (53.3%) were at high risk. One patient had a previous degenerated (severe aortic regurgitation) surgical bioprosthesis and underwent a transcatheter valve-in-valve procedure.25
Procedural and 30-day outcomes
Device and procedure
Discussion
The current report represents the first-year experience of a newly initiated contemporary TAVR program. The 30-day results from our TAVR program demonstrated excellent results compared with current published data. Several reasons may explain these findings. First, “shortening” of the learning curve and improvement in outcomes is to be expected in light of all the knowledge accumulated since 2002. Indeed, multiple lessons learned from the first large randomized trials and registries were central
Disclosures
PG has received speaker fees from Edwards Lifesciences. The other authors have no conflicts of interest to disclose.
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Cited by (7)
Transcatheter Aortic Valve Implantation: Finding Its Path
2015, Canadian Journal of CardiologyTransfemoral vs Non-transfemoral Access for Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis
2015, Canadian Journal of CardiologyCitation Excerpt :The total length of stay in the current analysis was similar in both groups at approximately 10 days, which predominantly reflects the early rather than contemporary TAVI eras. With greater percutaneous access and smaller devices, the observed length of stay is presently shorter with transfemoral access compared with historical cohorts included in this analysis.56 Certainly our study is not without limitations.
Starting Small But Aiming High: Important Lessons in Establishing a Successful TAVR Program
2014, Canadian Journal of CardiologyEarly Hemodynamic Results in Patients with Small Aortic Annulus after Aortic Valve Replacement
2017, Innovations: Technology and Techniques in Cardiothoracic and Vascular SurgeryVascular complications associated with transcatheter aortic valve replacement
2017, Vascular Medicine (United Kingdom)
See editorial by Nazif et al., pages 1506-1507 in this issue.
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