Feasibility and safety of a fully percutaneous transcatheter aortic valve replacement program.

Objectives: This study aimed to assess the feasibility and safety of conducting an entire transcatheter aortic valve replacement (TAVR) program by using percutaneous techniques only.

Background: Surgically assisted transthoracic TAVR has been reported to be associated with more complications and longer hospital stays.

Methods: During 2019, all TAVR at a single center were performed by standard transfemoral (TF), intravascular lithotripsy-assisted TF, transaxillary (TAx), or transcaval approach using percutaneous techniques only. No patients were denied TAVR because of access. Procedural and clinical endpoints were categorized using Valve Academic Research Consortium-2 criteria.

Results: In total, 306 consecutive TAVR patients were enrolled (mean age 78.9 ± 7.2 years). Most patients were treated by TF approach (94.8%)-of these, nine (2.9%) were pre-treated with intravascular lithotripsy. A percutaneous TAx and transcaval approach were used in 12 (3.9%) and four patients (1.3%), respectively. There were no procedural deaths and one peri-procedural stroke. Valve performance was satisfying in 298 patients (97.4%); six patients had a moderate aortic regurgitation and two patients had a mean gradient ≥20 mmHg following valve-in-valve procedure. The 30-day major vascular complication and major bleeding rate was 2.3% and 3.9%, respectively. A new permanent pacemaker was implanted in 41 patients (13.4%). Of all patients, 81% were discharged within two days post-TAVR, including 11 out of 12 TAx patients and all transcaval cases.

Conclusions: A fully percutaneous TAVR program is feasible and safe with favorable immediate and early clinical outcomes and allowing a short hospital stay.