TAVI: Simplification Is the Ultimate Sophistication

Abstract

Since its introduction in 2002, TAVI has evolved dramatically and is now standard of care for intermediate risk patients when the femoral approach can be implemented safely. The development of innovative transcatheter heart valves (THVs) and refinement of technical skills have contributed to the decrease in complication rates associated with TAVI⁴. Increased experience, smaller sheaths, rigorous pre-procedural planning and improved vascular closing techniques have resulted in markedly lower rates of vascular complications. The next step is the simplification of the procedure, which should contribute to a further decrease in complications, and also reduce procedural time, hospital stay as well as staff workload and costs. Moving to conscious sedation, no predilatation, no temporary pace maker and use of the radial approach as the contralateral approach are all instrumental in achieving this ultimate refinement.

Keywords: TAVI; hospital stay duration; minimalist; simplification; temporary pace maker; vascular complications.

Figure 1

Equipment and procedural set-up for a “minimalist” TAVI procedure.

Figure 2

Sheath size from first to last generation devices.

Figure 3

From left to right and up to down: Alligator clips with negative clip (black) and positive clip (red). After insertion of Sheath, a 22G needle is inserted subcutaneously through the skin, close to the femoral sheath and the positive clip is connected to the needle while the negative clip is connected to the guidewire. Setting of the temporary pacemaker with maximal output and minimal sensitivity. Pacing efficacy at 180 beats per minute with the LV wire and drop in blood pressure.