Initial experience with a novel, modular, minimalistic approach for transfemoral aortic valve implantation

Abstract

Objectives: We introduce a novel approach that involves a single arterial access and low contrast agent volume (SLIM).

Background: Transcatheter aortic valve implantation (TAVI) is subject to an ongoing process of refinement and simplification.

Methods: Between January 2019 and November 2020, a total 888 patients with severe aortic stenosis underwent transfemoral TAVI using balloon-expandable or specific self-expanding devices. The study cohort comprised patients with attempted SLIM approach (n = 291). A matched cohort of patients who were treated in a standard fashion served as control group (n = 291).

Results: The SLIM approach was successful in 92.4% of attempted cases. In the SLIM group, utilization of contrast agent (23 [19-37] vs. 75 [52-100] ml; p < 0.001), rates of any acute kidney injury (5.5% vs. 12.7%; p = 0.002), complications at the secondary access (0.3% vs. 3.1%; p = 0.011) and length of hospital stay (7 [5-8] vs. 7 [6-9]) days; p = 0.039) were significantly reduced. All other procedural outcomes were similar between groups.

Conclusions: Initial results of this novel, minimalistic approach demonstrate its feasibility and potential beneficial effects without compromising procedural safety. Further refinement of this approach is warranted.

Keywords: Acute kidney injury; Contrast agent; Single arterial access; TAVI.