Simplified TAVR Procedure: How Far Is It Possible to Go?
Florence LeclercqPierre Alain MeunierThomas GandetJean-Christophe MaciaDelphine DelsenyPhilippe GaudardMarc MouradLaurent SchmutzPierre RobertFrançois RoubilleGuillaume CaylaMariama AkodadPublished in: Journal of clinical medicine (2022)
Increasing operators' experience and improvement of the technique have resulted in a drastic reduction in complications following transcatheter aortic valve replacement (TAVR) in patients with lower surgical risk. In parallel, the procedure was considerably simplified, with a routine default approach including local anesthesia in the catheterization laboratory, percutaneous femoral approach, radial artery as the secondary access, prosthesis implantation without predilatation, left ventricle wire pacing and early discharge. Thus, the "simplified" TAVR adopted in most centers nowadays is a real revolution of the technique. However, simplified TAVR must be accompanied upstream by a rigorous selection of patients who can benefit from a minimalist procedure in order to guarantee its safety. The minimalist strategy must not become dogmatic and careful pre-, per- and post-procedural evaluation of patients with well-defined protocols guarantee optimal care following TAVR. This review aims to evaluate the benefits and limits of the simplified TAVR procedure in a current and future vision.
Keyphrases
- transcatheter aortic valve replacement
- aortic stenosis
- aortic valve
- minimally invasive
- ejection fraction
- ultrasound guided
- healthcare
- palliative care
- risk factors
- quality improvement
- coronary artery disease
- mitral valve
- current status
- chronic pain
- pain management
- heart failure
- health insurance
- pulmonary artery
- radiofrequency ablation
- affordable care act