TAVI, the road to a minimalist “stent-like” procedure

Since the First in Man implantation of a transcatheter bioprosthetic aortic valve in April 2002 in Rouen, the procedure has expanded worldwide. In our center, all trans-femoral (TF) procedures have been performed using local anesthesia without transesophageal echocardiographic. Herein, we report our experience of TF TAVI over the last 2 decades following the evolution of devices, practices, and indications. Between 2002 and 2021, 2097 consecutive patients had a TAVI procedure in our center. Among them, 1780 underwent TF TAVI and were subdivided into 3 groups according to the period: before 2009, between 2009 and 2014, and between 2014 and 2021. Median age was 85 years and remained unchanged. The mean logistic EuroSCORE gradually decreased over time (28% before 2009 vs. 15% between 2009 and 2014 vs 11% since 2014; P < 0.001). Pre-dilation was performed almost systematically before 2009 (93%) and rarely performed (14%) in the last period (P < 0.001). Length of stay has considerably decreased with a median of only 2 days after the procedure and more than 70% of patients discharged home within 72 hours in the last period. Similarly, procedural duration, X-ray time and contrast volume were reduced. Thirty-day all-cause mortality decreased over time and was 1.4% only in 2021. All-cause mortality at one-year gradually decreased from 30% before 2009 to 9.1% after 2014 (P < 0.001, Fig. 1). Trans-femoral aortic valve implantation performed as a minimalist “stent-like” procedure using only local anesthesia is feasible in the vast majority of patients with excellent outcomes.