Résumé
Abstract only
Introduction:
Admission to the intensive care unit (ICU) after transcatheter aortic valve implantation (TAVI) is a standard of care.
Hypothesis:
We assessed the hypothesis that TAVI can be performed safely without ICU admission in patients considered at low risk using simple clinical, ECG and echographic criteria.
Methods:
In this prospective monocentric cohort study we included all consecutive patients who underwent a TAVI procedure between December 2014 and May 2015. Low risk group included patients with LVEF > 40 %, transfemoral (TF) access, absence of severe pulmonary disease, stable hemodynamic state and absence of complications occurring until 2 hours after the procedure. High risk group included all other patients. Patients were admitted to the ICU or conventional cardiology unit depending on their risk evaluation. In-hospital major adverse events (VARC-2 criteria) were recorded in the two groups
Results:
On the 144 patients included, 67 were men (46.5 %), median age was 85 years (80-88) and median Euroscore II was 4.2 (3-6.9). The balloon expandable Edwards Sapien 3 valve was mainly used (n=118; 82%), with TF approach (n=136; 94.4% ) and general anesthesia (n=138; 95.8%). Of the 46 low risk patients (31.9%), only 1 was secondarily transferred to ICU due to non compressive pericardial effusion (minor complication) giving a negative predictive value of our triage strategy of 97.8% (CI:88.5-99.9). Conversely, of the 98 high risk patients, 40 developed major complications, mainly conductive disturbances. Positive predictive value was 40.8% (CI: 31.0-51.2). (Table 1)
By univariate analysis, the main pre procedural predictive factors of complications were use of self expandable prosthesis (p<0.00005) and right bundle branch block (p<0.004). In conclusion, our results suggested that TAVI can be performed safely without ICU admission in selected patients. This new “minimalist” strategy may optimize efficiency and cost effectiveness of the procedure.