Debate: Minimalist approach to TAVI as a selective strategy

Abstract

QUESTION: For starters, what is the minimalist approach to transcatether aortic valve implantation (TAVI)? ANSWER: Minimalist TAVI is a recent strategy to simplify the procedure, reduce possible complications, and favor early hospital discharges. This general definition can be explained by 2 keys aspects: what measures should be taken? And what patients should be eligible? Replacing general anesthesia and orotracheal intubation for sedation and local anesthesia are some of these measures. Sedation with the use of a laryngeal mask airway waking up the patient once the procedure is done is an intermediate situation. The type of hospital stay following TAVI is also an important aspect to be considered and it is associated with the type of anesthesia or sedation used: intensive care unit, post-anesthesia care unit or the hospital cardiac care unit. Other minimalist approaches during the procedure would be the access site used and the percutaneous closure, to avoid bladder catheterization, use the femoral venous access, use the radial, and not the femoral, artery for monitorization purposes, and to avoid the transesophageal echocardiogram. After the implantation, promoting early walking and removing IVs as soon as possible may also help. All these measures facilitate early hospital discharges. However, the hospital stays following...