Improving Efficiency in Performing Transcatheter Aortic Valve Replacement Procedure: Experience With 1000 TAVR Procedures

Abstract

Background

Since Food and Drug Administration approval of transcatheter aortic valve replacement (TAVR) in 2011, advancements in technology and procedural refinements have improved efficiency and safety. By systematically eliminating steps in the original TAVR protocol, we achieved reductions in procedural time, contrast volume, and fluoroscopy time without compromising outcomes.

Methods

Institutional TAVR data (November 2012 to September 2023) were analyzed, focusing on procedural times, contrast volume, radiation exposure, and outcomes. Four protocol modifications were compared: traditional protocol (2012 to 2016), elimination of rotational angiogram (2017 to 2020), elimination of balloon valvuloplasty (2020 to 2022), and elimination of femoral angiogram (2022 to 2023).

Results

Among 1095 TAVR procedures, 88.5% were femoral access, and 86.0% were done under conscious sedation. The mean age of patients was 79.0 ± 8.7 years, with 59% males. Most patients were classified in the Society of Thoracic Surgeons intermediate-risk category (38.4%), followed by prohibitive risk (30.0%), high risk (23.9%), and low risk (7.4%). Average procedural time, contrast volume, and fluoroscopy time were 88.4 ± 38.0 ​minutes, 73.0 ± 38.8 mL, and 13.8 ± 7.9 ​minutes, respectively. Adverse events occurred in 15%, with vascular complications (3.7%) being the most common. Mortality was 1.5%, highest in transapical (15%) and lowest in femoral (0.3%). Protocol modifications were associated with significant reductions in procedural time (59.99 ± 15.2 vs. 97.8 ± 33.9 ​minutes), contrast use (40.1 ± 26.6 vs. 92.9 ± 38.1 mL), fluoroscopy time (8.6 ± 7.4 vs. 18.5 ± 8.5 ​minutes), and complications (5.5 vs. 25.6%), all p ​< ​0.001.

Conclusions

Systematic elimination of procedural steps was associated with reduced procedural time, contrast use, and fluoroscopy time, without compromising patient safety. These refinements may enhance procedural efficiency and patient outcomes.