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Improving Efficiency in Performing Transcatheter Aortic Valve Replacement Procedure: Experience With 1000 TAVR
Mohammed Quader1,2, Neha Shah1, Rebecca Deitch1
1Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia.
Structural Heart : the Journal of the Heart Team
|September 2, 2025
Summary
Streamlining transcatheter aortic valve replacement (TAVR) by removing procedural steps significantly reduced procedure time, contrast volume, and fluoroscopy exposure. These TAVR protocol modifications improved efficiency without negatively impacting patient safety or outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Technology
Background:
- Transcatheter aortic valve replacement (TAVR) has advanced since FDA approval in 2011.
- Procedural refinements aim to enhance TAVR efficiency and safety.
Purpose of the Study:
- To evaluate the impact of systematically eliminating steps in the TAVR protocol.
- To assess reductions in procedural time, contrast volume, and fluoroscopy time.
- To determine if these modifications compromise patient outcomes.
Main Methods:
- Analysis of institutional TAVR data from November 2012 to September 2023.
- Comparison of four protocol modifications: traditional, elimination of rotational angiogram, elimination of balloon valvuloplasty, and elimination of femoral angiogram.
- Focus on procedural times, contrast volume, radiation exposure, and adverse events.
Main Results:
- Protocol modifications significantly reduced procedural time (59.99 vs. 97.8 min), contrast use (40.1 vs. 92.9 mL), and fluoroscopy time (8.6 vs. 18.5 min).
- Complication rates decreased from 25.6% to 5.5% (p < 0.001).
- Adverse events occurred in 15% of procedures, with vascular complications most common (3.7%).
Conclusions:
- Systematic elimination of TAVR procedural steps leads to significant reductions in time, contrast, and radiation.
- These protocol refinements enhance procedural efficiency without compromising patient safety.
- Optimized TAVR protocols may improve overall patient outcomes.
