Effect of procedural refinement of transfemoral transcatheter aortic valve implantation on outcomes and costs: a single-centre retrospective study

Abstract

ObjectivesTo determine the effect of introducing several procedural refinements of transfemoral transcatheter aortic valve implantation (TAVI) on clinical outcomes and costs.DesignRetrospective analysis comparing two consecutive 1-year periods, before and after the introduction of procedural refinements.SettingTertiary hospital aortic valve programme.ParticipantsConsecutive 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).InterventionsIntroduction of conscious sedation, percutaneous access and closure, omission of transoesophageal echocardiography during the procedure, and an early discharge procedure.Outcome measuresProcedural characteristics, complications and outcomes; length of stay in intensive care unit (ICU) and hospital; hospital-related direct costs associated with TAVI.ResultsThere 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.ConclusionsAmong 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.

The COORDINATE Pilot Study: Impact of a Transcatheter Aortic Valve Coordinator Program on Hospital and Patient Outcomes

“…TAVI pathways are complex and involve different medical personnel. Any modifications to the TAVI pathway may affect the staff workload, with associated cost implications [ 21 , 22 , 23 ]. In this pilot study, implementation of a TAVI coordinator reduced patient-related working hours for nurses (fewer hours on patient admission, diagnostic assessments, and working in the operating room and general ward) and medical assistants (less time on diagnostics and in the operating room).…”

Cost-Effectiveness and Clinical Outcome of Transcatheter Versus Sutureless Aortic Valve Replacement

“…Prosthesis brand-name, procedure improvements, and complications determine cost-effectiveness according to the sensitivity analysis of TAVI costs [31,32].…”