Key result
Streamlined transfemoral TAVI cuts ICU stay by ~50 hours without compromising mortality or complications.
Why the study?
The effect of introducing multiple procedural refinements for transfemoral TAVI on clinical outcomes and costs was unknown.
Does procedural refinement (conscious sedation, percutaneous access, omitting TEE) reduce costs and hospital stay without compromising safety in patients undergoing transfemoral TAVI?
Cohort (n=159)
No
Does procedural refinement (conscious sedation, percutaneous access, omitting TEE) reduce costs and hospital stay without compromising safety in patients undergoing transfemoral TAVI?
Absolute Event Rate: 7.9% vs 12.9%
p-value: p=0.299
Adopting a minimalist approach to transfemoral TAVI is safe and results in considerable operational efficiencies and cost savings.
Minimalist TAVI refinements were associated with shorter ICU stays and lower costs; hypothesis-generating and requires randomized confirmation.
Objectives: To determine the effect of introducing several procedural refinements of transfemoral transcatheter aortic valve implantation (TAVI) on clinical outcomes and costs. Design: Retrospective analysis comparing two consecutive 1-year periods, before and after the introduction of procedural refinements. Setting: Tertiary hospital aortic valve programme. Participants: Consecutive patients undergoing transfemoral TAVI treated between April 2014 and August 2015 using the initial setup (n=70; control group) or between September 2015 and August 2016 after the introduction of procedural refinements (n=89). Interventions: Introduction of conscious sedation, percutaneous access and closure, omission of transoesophageal echocardiography during the procedure, and an early discharge procedure. Outcome measures: Procedural characteristics, complications and outcomes; length of stay in intensive care unit (ICU) and hospital; hospital-related direct costs associated with TAVI. Results: There were no statistically significant differences in the incidence of complications or mortality between the two groups. The mean length of stay in the ICU was significantly shorter in the procedural-refinement group compared with the control group (5.1 vs 57.2 hours, p<0.001), as was the mean length of hospital stay (4.7 vs 6.6 days, p<0.001). The total cost per TAVI procedure was significantly lower, by £3580, in the procedural-refinement group (p<0.001). This was largely driven by lower ICU costs. Conclusions: Among patients undergoing transfemoral TAVI, procedural refinement facilitated a shorter stay in ICU and earlier discharge from hospital and was cost saving compared with the previous setup.
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Sangaraju et al. (2019) conducted a cohort in Severe aortic stenosis (n=159). Procedural refinements (conscious sedation, percutaneous access/closure, omission of periprocedural TEE) vs. Initial setup (general anaesthesia, surgical cut-down, routine TEE) was evaluated on All-cause mortality at 1 year (p=0.299). Procedural refinements for transfemoral TAVI significantly reduced mean intensive care unit stay by over 50 hours and per-procedure costs by £3580, with no significant differences in mortality or complication rates.
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