Minimalist Transcatheter Aortic Valve Replacement: The New Standard for Surgeons and Cardiologists Using Transfemoral Access?

The authors investigate the safety of minimally invasive Transcatheter Aortic Valve Replacement (MA-TAVR) and its learning curve.  MA-TAVR was performed by a team consisting of a cardiologist and cardiac surgeon. The patient was teated in a catheterization laboratory under conscious sedation. During the series the routine changed from transferring patients to the ICU to transferring patients to a regular telemetry room.  The authors found in 151 consecutive cases that the majority of patients were high surgical risk (STS-PROM of 10.0%). The rates of major stroke (3.3%), major vascular complications (3%) and paravalvular leak (7%) did not change over time.  The authors conclude that in a high-volume TAVR center, MA-TAVR is feasible. Moreover, they conclude that the learning curve for moving from regular TAVR to MA-TAVR is small and that TAVR centers actively pursue the minimalist technique.