A growing number of surgeons are performing elective transfemoral TAVRs in a cardiac catheterization laboratory rather than a hybrid operating room. The procedure requires local anesthesia rather than general anesthesia, percutaneous access and closure, minimal conscious sedation and transthoracic echocardiography. It’s a strategy that requires fewer resources and thus saves money.
In a paper published in the July 29 issue of the Journal of the American College of Cardiology: Cardiovascular Interventions , Babaliaros and colleagues compared costs and outcomes for patients who underwent elective transfemoral TAVRs at their center between November 2010 and September 2013. The center initiated a minimalist approach for transfemoral TAVRs in May 2012 and now uses the approach in about 95 percent of its transfemoral TAVR cases.
Babaliaros cautioned that experience is critical before transitioning to the minimalist approach. “Using this strategy we’ve had good outcomes, good safety short term and long term, and cost savings,” he said. Centers that have overcome the learning curve, are comfortable with transfemoral TAVR, adept with percutaneous access and closure and patient selection “should consider moving onto a minimalist approach. We are not advocating this as a strategy for a center that just started.”