Excellent Outcomes for Transcatheter Aortic Valve Replacement Within 1 Year of Opening a Low-Volume Centreand Consideration of Requirements

Florent Chevalier, Frédéric Poulin, Yoan Lamarche, Van Hoai Viet Le, Mélanie Gallant, Anik Daoust, Christophe Heylbroeck, Karim Serri, Yanick Beaulieu, Philippe Demers, Ismail El-Hamamsy, Hugues Jeanmart, Pierre Pagé, Erick Schampaert, Donald Palisaitis, Philippe Genereux

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: After the approval of transcatheter aortic valve replacement (TAVR) for high-risk or inoperable patients with severe aortic stenosis (AS), many low- and moderate-volume TAVR programs were initiated. Contemporary outcomes from these newly initiated centres remain unknown. Methods: In March 2013, our institution was authorized by the Québec Ministry of Health to perform 30 TAVR procedures. After thorough clinical screening and imaging evaluation, suitable patients underwent transfemoral TAVR with the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, CA) transcatheter heart valve (THV). In-hospital and 30-day outcomes were prospectively collected and reported according to Valve Academic Research Consortium 2 guidelines. Results: From April 2013 to January 2014, 30 consecutive high-risk (n= 16 [53.3%]) or inoperable (n= 14 [46.7%]) patients (mean age, 84.6 years; mean Society of Thoracic Surgery score, 7) with symptomatic severe AS underwent transfemoral TAVR. No catastrophic intraprocedural complications such as annulus rupture, valve embolization, aortic dissection, or coronary occlusion occurred, and there were no deaths at 30 days. Disabling stroke occurred in 1 (3.3%) patient 48 hours after THV implantation. Major vascular complications and major bleeding occurred in 1 (3.3%) patient. No moderate or severe paravalvular leak was observed. The median length of stay was 2 (1-3) days, with 8 (26.7%) patients discharged within 24 hours after the procedure. Conclusions: Excellent outcomes can be achieved in newly initiated relatively low-volume centres, which compares favorably to previously published large series. Important considerations include appropriate team training, rigorous patient screening, use of multimodality imaging techniques, a heart team approach, constant integration of lessons learned from larger published experiences, and maintaining a recommended minimum volume of 25 cases per year.

Original languageEnglish (US)
Pages (from-to)1576-1582
Number of pages7
JournalCanadian Journal of Cardiology
Volume30
Issue number12
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Heart Valves
Aortic Valve Stenosis
Coronary Occlusion
Transcatheter Aortic Valve Replacement
Aortic Valve
Thoracic Surgery
Blood Vessels
Dissection
Rupture
Length of Stay
Stroke
Guidelines
Hemorrhage
Health
Research

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Chevalier, Florent ; Poulin, Frédéric ; Lamarche, Yoan ; Viet Le, Van Hoai ; Gallant, Mélanie ; Daoust, Anik ; Heylbroeck, Christophe ; Serri, Karim ; Beaulieu, Yanick ; Demers, Philippe ; El-Hamamsy, Ismail ; Jeanmart, Hugues ; Pagé, Pierre ; Schampaert, Erick ; Palisaitis, Donald ; Genereux, Philippe. / Excellent Outcomes for Transcatheter Aortic Valve Replacement Within 1 Year of Opening a Low-Volume Centreand Consideration of Requirements. In: Canadian Journal of Cardiology. 2014 ; Vol. 30, No. 12. pp. 1576-1582.
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abstract = "Background: After the approval of transcatheter aortic valve replacement (TAVR) for high-risk or inoperable patients with severe aortic stenosis (AS), many low- and moderate-volume TAVR programs were initiated. Contemporary outcomes from these newly initiated centres remain unknown. Methods: In March 2013, our institution was authorized by the Qu{\'e}bec Ministry of Health to perform 30 TAVR procedures. After thorough clinical screening and imaging evaluation, suitable patients underwent transfemoral TAVR with the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, CA) transcatheter heart valve (THV). In-hospital and 30-day outcomes were prospectively collected and reported according to Valve Academic Research Consortium 2 guidelines. Results: From April 2013 to January 2014, 30 consecutive high-risk (n= 16 [53.3{\%}]) or inoperable (n= 14 [46.7{\%}]) patients (mean age, 84.6 years; mean Society of Thoracic Surgery score, 7) with symptomatic severe AS underwent transfemoral TAVR. No catastrophic intraprocedural complications such as annulus rupture, valve embolization, aortic dissection, or coronary occlusion occurred, and there were no deaths at 30 days. Disabling stroke occurred in 1 (3.3{\%}) patient 48 hours after THV implantation. Major vascular complications and major bleeding occurred in 1 (3.3{\%}) patient. No moderate or severe paravalvular leak was observed. The median length of stay was 2 (1-3) days, with 8 (26.7{\%}) patients discharged within 24 hours after the procedure. Conclusions: Excellent outcomes can be achieved in newly initiated relatively low-volume centres, which compares favorably to previously published large series. Important considerations include appropriate team training, rigorous patient screening, use of multimodality imaging techniques, a heart team approach, constant integration of lessons learned from larger published experiences, and maintaining a recommended minimum volume of 25 cases per year.",
author = "Florent Chevalier and Fr{\'e}d{\'e}ric Poulin and Yoan Lamarche and {Viet Le}, {Van Hoai} and M{\'e}lanie Gallant and Anik Daoust and Christophe Heylbroeck and Karim Serri and Yanick Beaulieu and Philippe Demers and Ismail El-Hamamsy and Hugues Jeanmart and Pierre Pag{\'e} and Erick Schampaert and Donald Palisaitis and Philippe Genereux",
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Chevalier, F, Poulin, F, Lamarche, Y, Viet Le, VH, Gallant, M, Daoust, A, Heylbroeck, C, Serri, K, Beaulieu, Y, Demers, P, El-Hamamsy, I, Jeanmart, H, Pagé, P, Schampaert, E, Palisaitis, D & Genereux, P 2014, 'Excellent Outcomes for Transcatheter Aortic Valve Replacement Within 1 Year of Opening a Low-Volume Centreand Consideration of Requirements', Canadian Journal of Cardiology, vol. 30, no. 12, pp. 1576-1582. https://doi.org/10.1016/j.cjca.2014.08.010

Excellent Outcomes for Transcatheter Aortic Valve Replacement Within 1 Year of Opening a Low-Volume Centreand Consideration of Requirements. / Chevalier, Florent; Poulin, Frédéric; Lamarche, Yoan; Viet Le, Van Hoai; Gallant, Mélanie; Daoust, Anik; Heylbroeck, Christophe; Serri, Karim; Beaulieu, Yanick; Demers, Philippe; El-Hamamsy, Ismail; Jeanmart, Hugues; Pagé, Pierre; Schampaert, Erick; Palisaitis, Donald; Genereux, Philippe.

In: Canadian Journal of Cardiology, Vol. 30, No. 12, 01.01.2014, p. 1576-1582.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Excellent Outcomes for Transcatheter Aortic Valve Replacement Within 1 Year of Opening a Low-Volume Centreand Consideration of Requirements

AU - Chevalier, Florent

AU - Poulin, Frédéric

AU - Lamarche, Yoan

AU - Viet Le, Van Hoai

AU - Gallant, Mélanie

AU - Daoust, Anik

AU - Heylbroeck, Christophe

AU - Serri, Karim

AU - Beaulieu, Yanick

AU - Demers, Philippe

AU - El-Hamamsy, Ismail

AU - Jeanmart, Hugues

AU - Pagé, Pierre

AU - Schampaert, Erick

AU - Palisaitis, Donald

AU - Genereux, Philippe

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: After the approval of transcatheter aortic valve replacement (TAVR) for high-risk or inoperable patients with severe aortic stenosis (AS), many low- and moderate-volume TAVR programs were initiated. Contemporary outcomes from these newly initiated centres remain unknown. Methods: In March 2013, our institution was authorized by the Québec Ministry of Health to perform 30 TAVR procedures. After thorough clinical screening and imaging evaluation, suitable patients underwent transfemoral TAVR with the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, CA) transcatheter heart valve (THV). In-hospital and 30-day outcomes were prospectively collected and reported according to Valve Academic Research Consortium 2 guidelines. Results: From April 2013 to January 2014, 30 consecutive high-risk (n= 16 [53.3%]) or inoperable (n= 14 [46.7%]) patients (mean age, 84.6 years; mean Society of Thoracic Surgery score, 7) with symptomatic severe AS underwent transfemoral TAVR. No catastrophic intraprocedural complications such as annulus rupture, valve embolization, aortic dissection, or coronary occlusion occurred, and there were no deaths at 30 days. Disabling stroke occurred in 1 (3.3%) patient 48 hours after THV implantation. Major vascular complications and major bleeding occurred in 1 (3.3%) patient. No moderate or severe paravalvular leak was observed. The median length of stay was 2 (1-3) days, with 8 (26.7%) patients discharged within 24 hours after the procedure. Conclusions: Excellent outcomes can be achieved in newly initiated relatively low-volume centres, which compares favorably to previously published large series. Important considerations include appropriate team training, rigorous patient screening, use of multimodality imaging techniques, a heart team approach, constant integration of lessons learned from larger published experiences, and maintaining a recommended minimum volume of 25 cases per year.

AB - Background: After the approval of transcatheter aortic valve replacement (TAVR) for high-risk or inoperable patients with severe aortic stenosis (AS), many low- and moderate-volume TAVR programs were initiated. Contemporary outcomes from these newly initiated centres remain unknown. Methods: In March 2013, our institution was authorized by the Québec Ministry of Health to perform 30 TAVR procedures. After thorough clinical screening and imaging evaluation, suitable patients underwent transfemoral TAVR with the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, CA) transcatheter heart valve (THV). In-hospital and 30-day outcomes were prospectively collected and reported according to Valve Academic Research Consortium 2 guidelines. Results: From April 2013 to January 2014, 30 consecutive high-risk (n= 16 [53.3%]) or inoperable (n= 14 [46.7%]) patients (mean age, 84.6 years; mean Society of Thoracic Surgery score, 7) with symptomatic severe AS underwent transfemoral TAVR. No catastrophic intraprocedural complications such as annulus rupture, valve embolization, aortic dissection, or coronary occlusion occurred, and there were no deaths at 30 days. Disabling stroke occurred in 1 (3.3%) patient 48 hours after THV implantation. Major vascular complications and major bleeding occurred in 1 (3.3%) patient. No moderate or severe paravalvular leak was observed. The median length of stay was 2 (1-3) days, with 8 (26.7%) patients discharged within 24 hours after the procedure. Conclusions: Excellent outcomes can be achieved in newly initiated relatively low-volume centres, which compares favorably to previously published large series. Important considerations include appropriate team training, rigorous patient screening, use of multimodality imaging techniques, a heart team approach, constant integration of lessons learned from larger published experiences, and maintaining a recommended minimum volume of 25 cases per year.

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