JACC: Cardiovascular Interventions RSS feed: Articles in Press. JACC: Cardiovascular Interventions encompasses the entire field of interventional cardiovascular medicine, including cardiac (coronary and non-coronary) peripheral and cerebrovascular interventions. JACC: Cardiovascular Interventions publishes studies that will impact the practice of interventional cardiovascular medicine including: Clinical trials that provide evidence to inform and alter practice guidelines Experimental studies that point to improved technologies and mechanistic understanding In-depth discussions of topics of interest by respected experts in the field Since interventional cardiovascular medicine is a highly visual specialty, the print journal is augmented by electronic publication allowing the latest technologies to be employed. http://www.jacccardiovascularinterventions.com//inpress?rss=yesElsevier Inc.en © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. JACC: Cardiovascular Interventions1936-87982012-05-07 © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jacccardiovascularinterventions.com/article/PIIS1936879812002385/abstract?rss=yes Objectives: The authors report the feasibility and 30-day outcomes of transfemoral aortic valve replacement (TAVR), using the Edwards SAPIEN (Edwards Lifesciences, Irvine, California) and Edwards SAPIEN XT (Edwards Lifesciences) prosthesis, implanted using exclusively local anesthesia and fluoroscopic guidance. Background: Transfemoral TAVR is often managed with general anesthesia. However, a simplified percutaneous approach using local anesthesia has become more popular because it offers multiple advantages in an elderly and fragile population. Methods: Between May 2006 and January 2011, the authors prospectively evaluated 151 consecutive patients (logistic euroSCORE: 22.8 ± 11.8%) who underwent TAVR (SAPIEN: n = 78, SAPIEN XT: n = 73) using only local anesthesia and fluoroscopic guidance. The primary endpoint was a combination of all-cause mortality, major stroke, life-threatening bleeding, stage 3 acute kidney injury (AKI), periprocedural myocardial infarction (MI), major vascular complication, and repeat procedure for valve-related dysfunction at 30 days. Results: Transarterial femoral approach was surgical in all SAPIEN procedures and percutaneous in 97.3% of SAPIEN XT, using the ProStar vascular closure device, and was well tolerated in all cases. Conversion to general anesthesia was required in 3.3% (SAPIEN cases) and was related to complications. Vasopressors were required in 5.5%. Procedural success was 95.4%. The combined-safety endpoint was reached in 15.9%, including overall mortality (6.6%), major stroke (2.0%), life-threatening bleeding (7.9%), stage 3 AKI (0.7%), periprocedural MI (1.3%), major vascular complication (7.9%), and repeat procedure for valve-related dysfunction (2.0%) at 30 days. A permanent pacemaker was required in 5.3%. Conclusions: This single-center, prospective registry demonstrated the feasibility and safety of a simplified transfemoral TAVR performed using only local anesthesia and fluoroscopic guidance in high surgical risk patients with severe aortic stenosis. Transfemoral Aortic Valve Replacement With the Edwards SAPIEN and Edwards SAPIEN XT Prosthesis Using Exclusively Local Anesthesia and Fluoroscopic Guidance: Feasibility and 30-Day Outcomes - Corrected ProofEric Durand, Bogdan Borz, Matthieu Godin, Christophe Tron, Pierre-Yves Litzler, Jean-Paul Bessou, Karim Bejar, Chiara Fraccaro, Carlos Sanchez-Giron, Jean-Nicolas Dacher, Fabrice Bauer, Alain Cribier, Hélène Eltchaninoff10.1016/j.jcin.2012.01.018JACC: Cardiovascular Interventions (2012)2012-05-07JACC: Cardiovascular Interventions2012-05-07FOCUSED ISSUE: TRANSCATHETER VALVE INTERVENTIONShttp://www.jacccardiovascularinterventions.com/article/PIIS1936879812002397/abstract?rss=yesThe Rouen Group needs to be congratulated for an impressive series of transcatheter aortic valve replacement (TAVR) cases performed with the “minimalist approach”: no general anesthesia (GA), no transesophageal echocardiography (TEE) guidance. Almost exactly 1 decade ago, in April 2002, Professor Alain Cribier led the first human TAVR performed in a compassionate case and did it with the patient under conscious sedation (CS) and local anesthesia (). Aortic valve implantation with a percutaneous approach obviates the need for sternotomy, cardiopulmonary bypass, and manipulation of the ascending aorta. This approach might also eliminate the need for tracheal intubation and GA.The Minimalist Approach for Transcatheter Aortic Valve Replacement in High-Risk Patients⁎ - Corrected ProofDanny Dvir, Rajiv Jhaveri, Augusto D. Pichard10.1016/j.jcin.2012.01.019JACC: Cardiovascular Interventions (2012)2012-05-07JACC: Cardiovascular Interventions2012-05-07EDITORIAL COMMENT