Comparison of TransFemoral Transcatheter Aortic Valve Replacement Performed With a Minimally Invasive Simplified Technique: "FAST" Versus a Standard Approach

To assess the safety and efficacy of a new simplified procedure for transfemoral (TF) transcatheter aortic valve replacement (TAVR): the FAST protocol. A minimalist approach for TF-TAVR has been reported. The goal of this simplified strategy is to reduce the rate of specific complications associated...

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Bibliographic Details
Published in:The Journal of invasive cardiology 2019-10, Vol.31 (10), p.300-306
Main Authors: Lefèvre, Grégoire, Jégou, Arnaud, Dambrin, Grégoire, Picard, Fabien, Anconina, Joseph, Pouzet, Bruno, Guesnier, Laurent, Cheikh Khelifa, Riadh, Hilpert, Loïc, Doan, Huy Long, Favereau, Xavier
Format: Article
Language:English
Subjects:
Aged, 80 and over
Aortic Valve Stenosis - surgery
Cardiac Catheterization - methods
Feasibility Studies
Female
Femoral Artery
Follow-Up Studies
France - epidemiology
Humans
Incidence
Length of Stay - trends
Male
Minimally Invasive Surgical Procedures - methods
Postoperative Complications - epidemiology
Postoperative Complications - prevention & control
Radial Artery
Retrospective Studies
Risk Factors
Survival Rate - trends
Transcatheter Aortic Valve Replacement - methods
Treatment Outcome
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Summary:To assess the safety and efficacy of a new simplified procedure for transfemoral (TF) transcatheter aortic valve replacement (TAVR): the FAST protocol. A minimalist approach for TF-TAVR has been reported. The goal of this simplified strategy is to reduce the rate of specific complications associated with general anesthesia, second vascular access, and use of temporary pacemaker, and to reduce the length of stay. We retrospectively reviewed all TF-TAVR cases performed at our center between January 2015 and December 2017. The FAST strategy consisted of local anesthesia with conscious sedation, echocardiographically guided TF puncture for main vascular access, radial approach for secondary arterial access, and left ventricular guidewire rapid pacing. Patients were sorted according to the initial strategy (FAST vs standard). The primary outcome was an early safety composite outcome including all-cause mortality, all stroke, life-threatening bleeding, acute kidney injury, coronary artery obstruction, major vascular complication, and valve-related dysfunction. A total of 285 consecutive patients were included in the present analysis (76 FAST patients and 209 standard patients). There were no baseline differences between groups. Complete FAST procedure was feasible in 83.0% of cases and all FAST procedures were successful. The primary outcome was significantly lower in the FAST group (1.3% vs 14.3%; P
ISSN:1557-2501