October 11, 2017Interactive Cardiovascular and Thoracic Surgery
Safety and efficacy of minimalist approach in transfemoral transcatheter aortic valve replacement: insights from the Optimized transCathEter vAlvular interventioN–Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry†
Key result
Minimalist TAVR linked to ~80% less major bleeding and similar mortality versus non-minimalist approaches.
- P=0.3
- n=921
Why the study?
Does a minimalist approach (local anaesthesia and conscious sedation) improve perioperative outcomes compared to a non-minimalist approach in patients undergoing transfemoral TAVR?
Population
921 Japanese patients with symptomatic, severe aortic stenosis undergoing elective transfemoral…
Comparison
Minimalist approach for TAVR, consisting of… vs Non-minimalist approach (NMA) for TAVR.
Design
Cohort
Follow-up
in-hospital
Authors
Discussion
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Implication
Supports reduced bleeding with minimalist transfemoral TAVR; leaves open need for randomized confirmation before practice change.
Study Design
Type
Observational (n=921)
Multicenter
Yes
Structured PICO
Does a minimalist approach (local anaesthesia and conscious sedation) improve perioperative outcomes compared to a non-minimalist approach in patients undergoing transfemoral TAVR?
P
Population
921 Japanese patients with symptomatic, severe aortic stenosis undergoing elective transfemoral-TAVR, evaluated retrospectively.
E
Exposure
Minimalist approach (MA) for TAVR, consisting of monitored anaesthesia care including local anaesthesia and conscious sedation.
C
Comparator
Non-minimalist approach (NMA) for TAVR.
O
Outcome
Perioperative results including in-hospital mortality and stroke/transient ischaemic attack.hard clinical
Main Result
Absolute Event Rate: 2.5% vs 0.8%
p-value: p=0.3
A minimalist approach for transfemoral TAVR using conscious sedation is as safe as a non-minimalist approach regarding mortality and stroke, while significantly reducing bleeding complications and hospital stay.
Cite This Study
Hosoba et al. (2017) conducted an observational in Symptomatic, severe aortic stenosis (n=921). Minimalist approach (MA) for TAVR vs. Non-minimalist approach (NMA) TAVR was evaluated on In-hospital mortality (p=0.3). A minimalist approach for transfemoral TAVR had similar in-hospital mortality (2.5% vs 0.8%, P=0.3) but significantly less major bleeding (3.4% vs 17%, P=0.003) than a non-minimalist approach.