Results of Streamlining TAVR Procedure Towards a Minimalist Approach： A Single Center Experience in Taiwan

Background: Trans-femoral transcatheter aortic valve replacement (TF-TAVR) performed under conscious sedation (LACS) is not yet become routine practice in Taiwan. We aimed to compared the results between patients received general anesthesia (GA) versus LACS. Methods Our cohort was divided into 3 groups: initial 48 patients received TF-TAVR under routine GA (GA group), subsequent 50 patients under routine LACS (LACS group 1), and recent 125 patients under LACS (LACS group 2). The baseline, procedural characteristics and all outcomes were prospectively collected and retrospectively compared. Results From Sep 2010 to July 2019, a total of 223 patients were included for The procedure time (157.6 ± 39.4 mins vs 131.6 ± 30.3 vs 95.2 ± 40.0, < 0.0001), contrast medium consumption (245.6 ± 92.6 ml vs 207.8 ± 77.9 vs 175.1 ± 64.6, < 0.0001), length of intensive care unit (2[1–5] days vs 2[1–3] vs 1[1–1], P = 0.0001) and hospital stay (9[7–13] days vs 8[6–11] vs 6 [5–9], P = 0.0001) decreased significantly with LACS, combined with a trend of less hospital acquired pneumonia (12.5% vs 6.0% vs 5.6%, P = 0.427). One-year survival rate were also different among 3 groups (83.3% vs 90.0% vs 93.6%, P = 0.053). Conclusion In our single center experience, a “minimalist” approach of TF-TAVR procedure resulted in less medical resources usage, along with more favorable clinical outcomes.