Minimalist transcatheter aortic valve replacement: The new standard for surgeons and cardiologists using transfemoral access?

BACKGROUND: A minimalist approach for transcatheter aortic valve replacement (MA-TAVR) utilizing transfemoral access under conscious sedation and transthoracic echocardiography is increasing in popularity. This relatively novel technique may necessitate a learning period to achieve proficiency in performing a successful and safe procedure. This report evaluates our MA-TAVR cohort with specific characterization between our early, midterm, and recent experience. METHODS: We retrospectively reviewed 151 consecutive patients who underwent MA-TAVR with surgeons and interventionists equally as primary operator at Emory University between May 2012 and July 2014. Our institution had performed 300 TAVR procedures before implementation of MA-TAVR. Patient characteristics and early outcomes were compared using Valve Academic Research Consortium 2 definitions among 3 groups: group 1 included the first 50 patients, group 2 included patients 51 to 100, and group 3 included patients 101 to 151. RESULTS: Median age for all patients was 84 years and similar among groups. The majority of patients were men (56%) and the median ejection fraction for all patients was 55% (interquartile range, 38.0%-60.0%). The majority of patients were high-risk surgical candidates with a median Society of Thoracic Surgeons Predicted Risk of Mortality of 10.0% and similar among groups. The overall major stroke rate was 3.3%, major vascular complications occurred in 3% of patients, and greater-than-mild paravalvular leak rate was 7%. In-hospital mortality and morbidity were similar among all 3 groups. CONCLUSIONS: In a high-volume TAVR center, transition to MA-TAVR is feasible with acceptable outcomes and a diminutive procedural learning curve. We advocate for TAVR centers to actively pursue the minimalist technique with equal representation by cardiologists and surgeons.

2012-2025 Roadmap of I.R.Iran's Disaster Health Management.

OBJECTIVE: In line with Iran's Comprehensive Health Sector Road Map, the National Institute of Health Research at the Tehran University of Medical Sciences developed the 2012-2025 road map of Disaster Health Management (DHM), including goals and objectives, strategies, activities and related prerequisites. This article presents the process and results of this road mapping project. METHODS: The project started with an expanded literature review followed by stakeholder analysis to assess level of interest and impact of related organizations to DHM; STEEP.V methodology to define determinants with a potential impact on Iran's HDM for duration of 2012 to 2025; strength, weakness, opportunity and threat (SWOT) analysis and formulation of goals and objectives, strategies, activities, and prerequisites. Brainstorming, group discussion and interviews with key informants were used for data collection; nominal group technique was used whenever prioritization was necessary, and Delphi panel methodology was applied for consensus development. RESULTS: STEEP.V analysis revealed the most important Social, Technological, Environmental, Economic, Political and Value-based determinants. Iran's DHM mission and vision were defined respectively as "Mitigation from, preparedness for, response to and recovery from consequences of natural and man-made hazards at the community level as well as to the health facilities and resources of I.R.Iran" and "In 2025, Iran's DHM will be the most developed system in the region resulting in the least vulnerability, the highest readiness in health facilities and resources, and the highest and most effective contribution of the Iranian community to disaster resilience", respectively. Sixteen strategies and related activities, along with the necessary prerequisites, were developed. CONCLUSIONS: This was the first attempt at comprehensive strategic planning in the field of DHM in Iran. The current framework provides Iran's health system with a list of strategies and activities to be considered in operational planning and actions. However, a dynamic process of evaluation and revision is required to ensure that Iran's health system goals are met by 2025. Address for correspondence: Ali Ardalan, No. 78, Italia Ave, Department of Disaster and Emergency Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran. Email: aardalan@gmail.com or aardalan@tums.ac.ir CITATION: Ardalan A, Rajaei MH, Masoumi G, Azin A, Zonoobi V, Sarvar M, Vaskoei Eshkevari K, Ahmadnezhad E, Jafari G. 2012-2025 Roadmap of I.R.Iran's Disaster Health Management. PLoS Currents Disasters. 2012 Jul 16.