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International audience; BACKGROUND:Currently, there are no recommendations regarding the minimum duration of in-hospital monitoring after transfemoral (TF) transcatheter aortic valve replacement (TAVR) and practices are extremely heterogeneous. We, therefore, aimed to evaluate length of stay (LOS) and predictive factors for late discharge after TF TAVR using data from the FRANCE TAVI registry.METHODS:TAVR was performed in 12,804 patients in 48 French centers between 2013 and 2015. LOS was evaluated in 5857 TF patients discharged home. LOS was calculated from TAVR procedure (day 0) to discharge. The study population was divided into three groups based on LOS values. Patients discharged within 3 days constituted the "very early" discharge group, patients with a LOS between 3 and 6 days constituted the "early" discharge group, and patients with a length of stay > 6 days constituted the "late" discharge group.RESULTS:The median LOS was 7 (5-9) days and was extremely variable among centers. The proportion of patients discharged very early, early, and late was 4.4% (n = 256), 33.7% (n = 1997), and 61.9% (n = 3624) respectively. Variables associated with late discharge were female sex, co-morbidities, major complications, self-expandable valve, general anesthesia, and a significant center effect. In contrast, history of previous pacemaker was a protective factor. The composite of death and re-admission in the very early and early versus late discharge groups was similar at 30 days (3.3% vs. 3.5%, p = 0.66).CONCLUSIONS:LOS is extremely variable after TF TAVR in France. Co-morbidities and complications were predictive factors of late discharge after TAVI. Interestingly, the use of self-expandable prosthesis and general anesthesia may also contribute to late discharge. Our results confirm that early discharge is safe.

Introduction Radial artery occlusion is the most common complication after coronary angiography performed by transradial access. It has been shown that heparin administration decreases the rate of radial artery occlusion but most of these studies were performed using 6 F arterial sheaths. There are few data regarding the radial artery occlusion rate after 4 French coronary angiography performed without heparin and with a reduced compression time. Objective To assess radial artery patency after diagnostic coronary angiography performed through a 4F sheath without heparin administration and with a short hemostasis time by manual compression. Methods In this observational study, patients referred for diagnostic coronary angiography from February 2017 to May 2017 underwent the procedure either using a 4 French arterial sheath, no heparin administration and a short manual compression time (Group 1) or using a 5 French arterial sheath, heparin administration and prolonged hemostasis by a compression wristband (Group 2). We assessed radial artery patency by continuous Doppler ultrasound after removal of the radial compression band, if any. Results Three thousand and eight patients were included, 51 (16.5%) in Group 1. Eleven cases of radial artery occlusion (3.57% of the study population) were diagnosed by Doppler, asymptomatic in all. Radial artery occlusion was more frequent in Group 1 (9.8% vs. 2.3%, P = 0.006). Lower weight (P = 0.04) and lower heparin dose (P = 0.005) were associated with an increased risk of radial occlusion. Conclusion Four French transradial coronary angiography without heparin led to an increased risk of radial artery occlusion compared to a strategy of 5 French coronary angiography with heparin administration.

Background As the pioneer center in the transcatheter aortic valve implantation (TAVI) our experience provides the longest follow-up. The number of nonagenarians is rising dramatically. These patients often develop aortic stenosis. Purpose We aimed to assess the safety and long-term outcomes after TAVI in this population in our center from 2002 to 2016. Methods All patients treated by TAVI in our center were included prospectively. Clinical and echocardiographic follow-up was performed at 30 days and yearly. Two groups were defined according to age: “ Results A total of 1071 patients underwent TAVI during the period. One hundred and fifty-four were age “≥ 90”. Mean logistic EuroSCORE was lower in “≥ 90” (18.3 ± 11.8% vs. 20.8 ± 11.7%, P = 0.01). “≥ 90” had less diabetes mellitus (17.1 vs. 29.9%, P = 0.001), less peripheral arterial disease (10.4% vs. 16.6%, P = 0.05), less chronic obstructive pulmonary disease (8.5% vs. 20.1%, P = 0.001), and less severe pulmonary hypertension (4.5% vs. 12.2% vs. 4.5%, P = 0.01). “≥ 90” also had less prevalence of cancer (11.8% vs. 20.7%, P = 0.03), less coronary artery bypass surgery (0.6% vs.12.6%, P Fig. 1 ). The life expectancy of these patients was comparable a population of the same age without aortic stenosis. Conclusion Nonagenarians have less comorbidities. They benefit most from transfemoral approach. Outcomes are comparable to the overall population. TAVI is a safe and life-saving treatment in well-selected nonagenarian population.

Major vascular complications (VC) remain an important issue after transfemoral transcatheter aortic valve implantation (TF-TAVI). Previous studies demonstrated that major VC were frequent with first-generation of transcatheter heart valves (THV) and were associated with higher 30-day mortality using

Background In the context of extension of transcatheter aortic valve implantation (TAVI) indications, transcatheter heart valve durability is a pivotal concern. Being the pioneer center since Fist-In-Man TAVI provides us the longest worldwide follow-up. Purpose We aimed to report long-term outcomes and assess valve durability by evaluating structural valve deterioration (SVD) in patients treated with balloon-expandable TAVI prior to 2011. Methods From 2002 to 2011, 242 patients underwent balloon-expandable TAVI in our center. On site clinical and echocardiographic follow-up were scheduled at one month, one year and yearly thereafter. In the absence of universal definition of SVD, we used the surgical definition, survival without reintervention, and proposed a definition using echocardiographic criteria. SVD was considered moderate when mean aortic gradient was ≥ 20 mmHg and Results Mean age was 82.2 years. Patients were highly symptomatic (79.1% in NYHA III/IV), mean logistic Euroscore was 25.5 ± 14.2%. 30-day mortality was 12.1%. Survival rate was 68.3 ± 3.0%, 26.9 ± 2.9%, and 5.3 ± 2.0% at one-, 5- and 10-years, respectively. Using surgical definition, only one patient required reintervention for symptomatic SVD and freedom from SVD at 10y was 93.8 ± 6.1%. According to our definition, 1 patient had probable severe SVD, 2 had probable moderate SVD, 1 had possible moderate SVD and freedom from SVD at 10 y was 87.7 ± 6.6% ( Fig. 1 ). Conclusions Our data do not demonstrate an alarm on durability. Long-term assessment of transcatheter aortic valve is difficult given the high mortality of the studies population. Further studies are required to estimate accurately TAVI durability. When assessing SVD and comparing TAVI to surgery, SVD definition should be universal.

Introduction Since the first-in-man transcatheter aortic valve implantation (TAVI) performed by our group in 2002, the number of procedures has dramatically increased. Currently restricted to inoperable and high-risk patients TAVI is likely to be extended to lower risk patients. However, long-term data regarding valve durability are missing. We aimed to report our experience with long-term follow-up to assess long-term mortality and valve durability. Methods All consecutive patients presenting with severe symptomatic aortic stenosis treated by TAVI were included prospectively. Clinical and echocardiographic follow-up was performed at 30 days and annually thereafter. Survival curves were constructed using Kaplan-Meier analysis. We also evaluated valve durability and the incidence of infective endocarditis. Results Between 2002 and 2015, 784 consecutive patients (age: 83.3±9.4 years, logistic EuroSCORE of 19.6±12.1%) underwent TAVI including 634 (80.9%) patients via a femoral approach. A balloon-expandable transcatheter heart valve (THV) was predominantly used (747 Pts; 95.3%): 68 Cribier- Edwards, 114 Sapien, 482 Sapien XT, and 83 Sapien 3 since July 2014. Thirty-day mortality dramatically decreased from 22.1% using the Cribier- Edwards in compassionate patients to 1.3% with the Sapien 3 (p Conclusions Long-term (up to 9 years) follow-up of our large series of patients treated by TAVI demonstrates no warning signs of valve deterioration suggesting very encouraging valve durability, using predominantly, a balloon expandable prosthesis The author declares a conflict of interest: Helene Eltchaninoff, Pierre-Yves Litzler and Alain Cribier are consultants for Edwards Lifesciences. Other authors have no disclosure. Download : Download full-size image Figure . Survival analysis by Kaplan-Meier