Incisionless transcatheter aortic valve replacement surgery cuts hospital length of stay

July 24, 2014

New research from Penn Medicine shows that incisionless transcatheter aortic valve replacement (TAVR) surgery cuts length of hospital stay by 30 percent and has no impact on post-operative vascular complication rates when compared with conventional transfemoral TAVR, which requires an incision in the groin. The complete study is available in the current issue of Circulation: Cardiovascular Interventions.

TAVR involves the replacement of the without a traditional open-heart surgical approach. It is a treatment for aortic stenosis, a narrowing of the aortic valve opening. The surgery can be performed in two ways, both involving the insertion of a sheath into the which allows the new valve to be threaded up to the patient's chest via a catheter. The traditional transfemoral approach requires a several inch incision in the groin. More recently, physicians have begun to employ an incisionless or percutaneous approach, which requires no more than a pin-prick to access the femoral artery. Patients leave the hospital without an incision of any kind and little to no trace that a surgery was performed.

"It has been our clinical experience that there is little difference in vascular outcomes between traditional and percutaneous TAVR surgery but we wanted to take a closer look at the data and understand how these techniques performed in a side by side comparison on vascular complications, outcomes and hospital length of stay," says senior author Jay Giri, MD, MPH, assistant professor in the division of Cardiovascular Medicine at the Perelman School of Medicine at the University of Pennsylvania.

Giri and his co-authors examined 120 patients who underwent TAVR via the traditional method and 211 patients who had percutaneous TAVR surgery at the Hospital of the University of Pennsylvania or Penn Presbyterian Medical Center between 2007 and 2013. They observed a shorter postprocedural length of hospital stay (7.5 versus 9.9 days) in patients who received percutaneous surgery versus traditional TAVR surgery and no difference in vascular complication rates between the two procedures.

Vascular complications can include hematomas, large bruises under the skin; dissections, tears in the vessel walls putting the vessels at risk for closure; and the rupture of blood vessels, among others. The Penn researchers discovered that vascular complications were tied to the sex of the patient, with females appearing to be at greater risk of complications than males. This issue will be the subject of further research.

Higher rates of vascular complications were also associated with larger valve introducer sheath outer diameter compared with patients' artery diameter. The "introducer" sheaths can easily nick or disrupt the vessels in transit and cause complications for the patient, whether they have traditional or percutaneous surgery. "While there are clinical circumstances when oversized sheaths must be used to accomplish a life-saving procedure, we discovered that, contrary to conventional wisdom, there really is no such thing as a 'safe oversize', says Giri."

Previous studies had not examined the association of percutaneous and traditional surgery approaches with vascular complications in a wide cross section of patients with the full range of sheath sizes available in the US. This is also the first study to show increasing harm with increasing sheath oversizing. Vascular complication rates are expected to decrease as technology advances and sheath sizes continue to decrease in relation to artery diameter. Currently, however, the authors warn, careful preprocedural planning with respect to the relationship between sheath size and artery diameter is warranted.

Explore further: Study compares heart valve systems

More information: Circulation: Cardiovascular Interventions. DOI: 10.1161/CIRCINTERVENTIONS.113.001030

Related Stories

Study compares heart valve systems

March 30, 2014
Among patients undergoing aortic valve replacement using a catheter tube, a comparison of two types of heart valve technologies, balloon-expandable or self-expandable valve systems, found a greater rate of device success ...

How long is too long to wait for groundbreaking aortic valve replacement surgery?

June 3, 2014
Severe aortic stenosis (AS) has a grave prognosis with 25-50% of patients dying within a year once symptoms develop. Transcatheter aortic valve replacement (TAVR) represents a paradigm shift in the therapeutic options for ...

Fewer deaths with self-expanding TAVR versus surgery at one year

March 31, 2014
Transcatheter aortic valve replacement with a self-expanding valve prosthesis for the first time has demonstrated significantly lower death rates at one year compared with conventional surgical valve replacement in high-risk ...

Study confirms benefits of transcatheter aortic valve replacement over 3 years

October 24, 2012
A study found that transcatheter aortic valve replacement (TAVR) yielded lower mortality rates after three years compared with medical therapy in patients deemed to be ineligible for conventional aortic valve surgery. Results ...

Study examines effectiveness, safety of transcatheter aortic valve replacement in US

November 17, 2013
Michael J. Mack, M.D., of the Baylor Health Care System, Plano, Texas, and colleagues describe the experience in the U.S. with transcatheter aortic valve replacement (TAVR), including patient selection, procedural details, ...

Recommended for you

Cholesterol crystals are sure sign a heart attack may loom

August 17, 2017
A new Michigan State University study on 240 emergency room patients shows just how much of a role a person's cholesterol plays, when in a crystallized state, during a heart attack.

How Gata4 helps mend a broken heart

August 15, 2017
During a heart attack, blood stops flowing into the heart; starved for oxygen, part of the heart muscle dies. The heart muscle does not regenerate; instead it replaces dead tissue with scars made of cells called fibroblasts ...

Injectable tissue patch could help repair damaged organs

August 14, 2017
A team of U of T Engineering researchers is mending broken hearts with an expanding tissue bandage a little smaller than a postage stamp.

'Fat but fit' are at increased risk of heart disease

August 14, 2017
Carrying extra weight could raise your risk of heart attack by more than a quarter, even if you are otherwise healthy.

Air pollution linked to cardiovascular disease; air purifiers may lessen impact

August 14, 2017
Exposure to high levels of air pollution increased stress hormone levels and negative metabolic changes in otherwise healthy, young adults in a recent study conducted in China. Air purifiers appeared to lessen the negative ...

Study hints at experimental therapy for heart fibrosis

August 14, 2017
Researchers report encouraging preclinical results as they pursue elusive therapeutic strategies to repair scarred and poorly functioning heart tissues after cardiac injury—describing an experimental molecular treatment ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.