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Review
. 2022 Sep;24(9):1179-1187.
doi: 10.1007/s11886-022-01737-x. Epub 2022 Jun 29.

Update on Minimalist TAVR Care Pathways: Approaches to Care in 2022

Mariem A Sawan  1 , Avery E Calhoun  2 , Kendra J Grubb  3 , Chandan M Devireddy  4
Affiliations
Review

Update on Minimalist TAVR Care Pathways: Approaches to Care in 2022

Mariem A Sawan et al. Curr Cardiol Rep. 2022 Sep.

Abstract

Purpose of review: This review summarizes current data supporting a minimalist TAVR approach and identifies the need for additional study to optimize TAVR care. The authors discuss future directions of the TAVR landscape and how this necessitates evolution of minimalist care pathways.

Recent findings: Transcatheter aortic valve replacement (TAVR) has become a mainstay in the treatment of aortic stenosis since the initial procedure in 2002. Recently, attention has shifted to TAVR optimization and the minimalist approach with a focus on minimizing procedural sedation, protocolization of perioperative management, and prioritization on early discharge. This approach has been shown to be safe and reduce procedure time, length of stay, and overall cost for hospital systems. The minimalist care pathway avoids general anesthesia, shortens procedure time and length of stay, and reduces cost without changing mortality or readmission rates at 30 days. A variety of protocols have been proposed without a clear consensus on specific components or patient eligibility. There is a continued need for data regarding patient risk stratification, valve selection, and discharge strategy as TAVR becomes increasingly common.

Keywords: Minimalist TAVR; Minimalist care pathway; Next-day discharge; Same-day discharge; Transcatheter aortic valve replacement (TAVR).

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Conflict of interest statement

Dr. Chandan M. Devireddy receives compensation for the following roles: Medtronic: Consultant; Edwards Lifesciences: Proctor; ReCor Medical: Consultant; and Shockwave Medical: Consultant. Dr. Kendra Grub reports consulting fees from Medtronic, Abbot, W.L. Gore, and 4C Medical. She also reports payment or honoraria from Medtronic, Edwards Lifesciences (Institution), Boston Scientific, and OpSens. The other authors declare that they have no conflict of interest.

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