TAVR in Cath Lab vs. Operating Room?

Nov 14, 2018
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Authors:
Spaziano M, Lefèvre T, Romano M, et al.
Citation:
Transcatheter Aortic Valve Replacement in the Catheterization Laboratory Versus Hybrid Operating Room: Insights From the FRANCE TAVI Registry. JACC Cardiovasc Interv 2018;11:2195-2203.
Summary By:
Bina Ahmed, MD, FACC

Study Questions:

Is there a difference in outcomes among transcatheter aortic valve replacement (TAVR) procedures performed in the cardiac catheterization laboratory (cath lab) compared to the hybrid operating room (OR)?

Methods:

All TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. The primary endpoint of this study was all-cause mortality at 1 year. Secondary endpoints consisted of 30-day complications and 3-year mortality. All analyses were adjusted for baseline and procedural characteristics.

Results:

Of the total 12,121 patients included in this study, 62% underwent TAVR in a cath lab versus 38% in a hybrid OR. Mean age was 82.9 ± 7.2 years and mean Logistic EuroScore was 17.9% ± 12.3%. After adjusting for baseline and procedural characteristics, major bleeding and infections were significantly higher in the hybrid OR group (bleeding, 6.3% vs. 4.8%; infection, 6.1% vs. 3.5%; p < 0.05). Adjusted mortality rates at 1 and 3 years did not differ significantly between groups (for cath lab vs. hybrid OR, respectively: 1 year: 16.2% vs. 15.8%; p = 0.91; 3 years: 38.4% vs. 36.4%; p = 0.49).

Conclusions:

There were increased bleeding and infection rates when TAVR was performed in the hybrid OR. However, TAVR procedure location was not associated with short- or mid-term mortality.

Perspective:

The fine-tuning of TAVR procedures continues with an increasing number of procedures performed in cath labs with increasing use of a minimalist approach. The findings of this study show no difference in mortality between TAVR procedures done in the OR compared to the cath lab. Overall rates of procedural complications were low in both groups. There was a signal for increased bleeding in the nonfemoral access group who had TAVR in the hybrid OR and overall higher rates of infections requiring antibiotics in the OR. Further analysis should evaluate cost implications of both location and minimalist TAVR in current practice.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: Anti-Bacterial Agents, Cardiac Catheterization, Heart Valve Diseases, Heart Valve Prosthesis, Hemorrhage, Infections, Operating Rooms, Transcatheter Aortic Valve Replacement, Treatment Outcome


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