A semi-rapid deployment workflow to reduce device time in Evolut FX self-expanding transcatheter aortic valve...

As transcatheter aortic valve implantation (TAVI) expands, improving deployment efficiency is increasingly important. We developed and implemented a semi-rapid pacing-assisted deployment workflow for the Evolut platform.

We sought to evaluate the procedural efficiency and early safety of this workflow for transfemoral (TF) Evolut FX TAVI.

In a single-centre registry, we performed a retrospective before-and-after analysis of consecutive TF Evolut FX procedures: semi-rapid deployment (n=48) versus conventional deployment (n=53). Device time was defined as the interval from initial advancement of the delivery system to final release of the Evolut FX valve. Prolonged device time was defined as >14 minutes (>75th percentile), and determinants were assessed using Firth's penalised logistic regression.

The device time was shorter with semi-rapid deployment (9.0 [interquartile range [IQR] 6.0-13.0] minutes vs 14.0 [IQR 11.0-16.0] minutes; p<0.001), while operation and procedure times were similar (p=0.13 and p=0.16, respectively). The mean recapture count was higher in the semi-rapid group (0.85±1.09 vs 0.53±0.70; p=0.08), and contrast volume was higher (32.0 [IQR 25.0-42.0] mL vs 25.0 [IQR 15.0-33.0] mL; p=0.008). Paravalvular leak >=mild (31.2% vs 32.1%; p=1.0) and in-hospital pacemaker implantation (2.1% vs 7.5%; p=0.37) did not differ significantly between the groups. In multivariable analysis, recapture predicted a prolonged device time (adjusted odds ratio [OR] 4.74, 95% confidence interval [CI]: 1.75-14.19; p=0.002), whereas the semi-rapid workflow predicted a reduced device time (adjusted OR 0.10, 95% CI: 0.01-0.66; p=0.015).

Semi-rapid pacing-assisted Evolut FX deployment selectively reduced device time without compromising early in-hospital safety outcomes. Deployment efficiency represents a practical procedural target for workflow refinement in self-expanding TAVI.