Update on Minimalist TAVR Care Pathways: Approaches to Care in 2022

• Type of Material: Article
• Authors: Mariem A. Sawan, Emory University; Avery E. Calhoun, Emory University; Kendra Grubb, Emory University; Chandan Devireddy, Emory University
• Language: English
• Date: 2022-06-29
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022
• Final Published Version (URL): http://dx.doi.org/10.1007/s11886-022-01737-x
• Title of Journal or Parent Work: CURRENT CARDIOLOGY REPORTS
• Keywords: Cardiovascular System & Cardiology; Same-day discharge; REGISTRY; Transcatheter aortic valve replacement (TAVR); IMPLANTATION; Minimalist care pathway; Cardiac & Cardiovascular Systems; Science & Technology; COMPLICATIONS; AORTIC-VALVE-REPLACEMENT; NEXT-DAY-DISCHARGE; Life Sciences & Biomedicine; SAFETY; Next-day discharge; Minimalist TAVR; CLINICAL-OUTCOMES
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Purpose of Review: This review summarizes current data supporting a minimalist TAVR approach and identifies the need for additional study to optimize TAVR care. The authors discuss future directions of the TAVR landscape and how this necessitates evolution of minimalist care pathways. Recent Findings: Transcatheter aortic valve replacement (TAVR) has become a mainstay in the treatment of aortic stenosis since the initial procedure in 2002. Recently, attention has shifted to TAVR optimization and the minimalist approach with a focus on minimizing procedural sedation, protocolization of perioperative management, and prioritization on early discharge. This approach has been shown to be safe and reduce procedure time, length of stay, and overall cost for hospital systems. Summary: The minimalist care pathway avoids general anesthesia, shortens procedure time and length of stay, and reduces cost without changing mortality or readmission rates at 30 days. A variety of protocols have been proposed without a clear consensus on specific components or patient eligibility. There is a continued need for data regarding patient risk stratification, valve selection, and discharge strategy as TAVR becomes increasingly common.