• Guilherme F Attizzani, Ahmad Alkhalil, Bimal Padaliya, Chor-Cheung Tam, Joao Pedro Lopes, Anas Fares, Hiram G Bezerra, Benjamin Medallion, Soon Park, Salil Deo, Basar Sareyyupoglu, Sahil Parikh, David Zidar, Yakov Elgudin, Kehllee Popovich, Angela Davis, Elizabeth Staunton, Ana Tomic, Stacey Mazzurco, Edward Avery, Alan Markowitz, Daniel I Simon, and Marco A Costa.
• The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio. Electronic address: guilherme.attizzani@uhhospitals.org.
• Am. J. Cardiol. 2015 Dec 1; 116 (11): 1731-6.

AbstractSome centers, mostly in Europe, have demonstrated the feasibility of a minimally invasive strategy (MIS; i.e., local anesthesia and conscious sedation, performed in the cath laboratory without transesophageal echocardiography guidance). Nonetheless, the experience of MIS for TAVI using both commercially available valves is lacking in the United States. We, therefore, retrospectively studied all transfemoral TAVI cases performed at our institution between March 2011 and November 2014 to assess the safety and efficacy of MIS. Patients were dichotomized according to the strategy (MIS vs conventional strategy [CS]) used for the procedure. One hundred sixteen patients were included in the MIS group and 91 patients were included in the CS group. Baseline characteristics were similar, and procedural success was comparable (99.1% in MIS and 98.9% in CS, p = 1). One intraprocedural death occurred in each group, whereas conversion rates to general anesthesia were low (3.4%). Comparable device success was obtained. Rates of complications and >mild paravalvular leak before discharge were low and comparable. Length of hospital stay was significantly reduced in the MIS (median, 3.0 [2.0 to 5.0] days) compared with than that in CS group (median 6.0 days [3.5, 8.0]). At a median follow-up of 230 days, no significant difference in survival rate was detected (89% vs 88%, p = 0.9). On average, MIS was associated with remarkable cost saving compared with CS ($16,000/case). In conclusion, TAVI through MIS was associated with a shorter postprocedural hospital stay, lower costs, and similar safety profile while keeping procedural efficacy compared with CS.Copyright © 2015 Elsevier Inc. All rights reserved.

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