Résumé
While admission in the intensive care unit (ICU) has been regarded as an essential step after transcatheter aortic valve implantation (TAVI), the improvement of the results of the technique calls into question this systematic approach.
To evaluate feasibility and safety of TAVI performed without ICU admission in patients considered at low risk according to simple clinical, ECG, and echographic criteria.
Between December 2014 and May 2015, we included in a prospective monocentric cohort study 99 consecutive patients undergoing TAVI. Low risk group included patients with LVEF>40%, absence of severe pulmonary disease, transfemoral (TF) access, stable hemodynamic state and absence of complications occurring until 2 hours after the procedure. High risk group included all other patients. Major in hospital cardiovascular adverse events were recorded in the two groups (VARC-2 criteria).
The study included 47 men (47.5%) and median age was 84 years (79-88). Median Euroscore II was 4.1 (3.1-6.6). The balloon expandable Sapien 3 valve was mainly used (79.6%; n=78), with TF approach and general anesthesia for the majority of the patients (95.9% and 94.9%). A total 33 patients (33%) considered at low risk were admitted in the conventional cardiology unit. At follow-up, only one low-risk patient (3.0%) developed a minor complication (non compressive pericardial effusion with spontaneous resolution) giving a NPV of the model of 97% (CI:0.84-1.0). Conversely, 21 patients (31.8%) from the high-risk group developed complications (PPV: 31.8%; CI: 0.21-0.44) (Table).
The results of our study suggest that TAVI procedure can be performed safely without ICU admission in selected patients. This new “minimalist” strategy concerned one third of our patients but may probably be extended considering the relatively low rate of events in the ICU admitted group.Abstract 0205 – Table: Cardiovascular adverse events in the two groups of patientsPost TAVI adverse eventsLow risk group (n=33)High risk group (n=66)Death (n=1)01 (1.5%)New conductive disorder (n=17)017 (17.2%)Permanent pacing requirement (n=14)014 (14,1%)Major vascular complications (n=1)01 (1.01%)Pericardial effusion>10mm- cardiac tamponnade (n=2)02 (2.02%)- non compressive (n=1)1 (3%)0TOTAL (n=22)1 (3%)21 (31.8%)