Comparison of transfemoral transcatheter aortic valve replacement performed with a simplified protocol: “FAST-TAVR” versus standard approach

Background A minimalist approach for transfemoral transcatheter aortic valve replacement (TF-TAVR) procedures is already the standard of care in many experienced centers. The goal of this simplified strategy is to avoid specific iatrogenic complications associated to general anesthesia, second vascular access and use of temporary pacemaker, and to reduce the length of stay. Purpose To assess the safety and efficacy of a new simplified procedure for TF-TAVR: the FAST-TAVR protocol. Methods We retrospectively studied all TF-TAVR cases performed in our center between January 2015 and December 2017. The FAST-TAVR strategy consisted of local anaesthesia or conscious sedation, echo guided transfemoral puncture for main vascular access, radial approach for secondary arterial access, and left ventricular guide wire rapid pacing. Patients were sorted according to the strategy (FAST-TAVR vs Standard-TAVR). Results A total of 285 consecutive patients were included (FAST-TAVR, n  = 76 vs. Standard-TAVR, n  = 209). There were no baseline differences between groups. Complete FAST-TAVR procedure was feasible in 83% of cases and all FAST-TAVR procedures were successful. Total procedure time (117.5 vs. 127 min, P  = 0.01), fluoroscopy time (13.2 vs. 15.9 min, P  = 0.02), balloon pre-dilatation (2.6 vs. 19.6%, P P  = 0.007) were significantly lower in the FAST-TAVR group. 30-days mortality (0 vs. 4.8%, P  = 0.07), rate of stroke/transient ischemic attack (0 vs. 1.9%, P  = 0.58) were not significantly different. The use of the FAST-TAVR protocol resulted in a reduction of major bleeding (1.3 vs. 10.1%, P  = 0.01), blood transfusion (2.6 vs. 14.3, P  = 0.006), and vascular complications related to secondary access (0 vs. 5.3%, P  = 0.04). Conclusion FAST-TAVR can be performed safely and is associated with lower rates of iatrogenic complications. The shorter length of stay and the use of lower resource could be an additional argument to extend FAST-TAVR indications.