The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany

2017 ◽  
Vol 19 (2) ◽  
pp. 223-228 ◽  
Author(s):  
Klaus Kaier ◽  
Holger Reinecke ◽  
Huseyin Naci ◽  
Lutz Frankenstein ◽  
Martin Bode ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Aortic Valve ◽  
Length Of Stay ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Procedural Complications ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
The Impact

Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation

Heart ◽  
2018 ◽  
Vol 104 (19) ◽  
pp. 1621-1628 ◽  
Author(s):  
Mehdi Eskandari ◽  
Omar Aldalati ◽  
Rafal Dworakowski ◽  
Jonathan A Byrne ◽  
Emma Alcock ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
General Anaesthesia ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Aortic Valve Implantation ◽  
The Uk ◽  
Valve Implantation ◽  
The Impact

ObjectivePerforming transfemoral transcatheter aortic valve implantation (TAVI) without general anaesthesia (GA) has been increasingly adopted. We sought to study the impact of GA and non-GA approaches on procedural outcome and 30-day and 1-year mortality in transfemoral TAVI.MethodsThe UK TAVI registry holds information for every TAVI procedure in the UK. We analysed the data for patients implanted during 2013–2014 using either an Edwards Sapien or a Medtronic CoreValve prosthesis. Propensity score-matching analysis was performed to adjust for confounding factors.Results2243 patients were studied (aged 81.4±7.5 years, 1195 males). 1816 (81%) underwent TAVI with GA and 427 (19%) without GA. Transoesophageal echocardiography (TOE) was used in 92.3% of GA and 12.4% of non-GA cases (p<0.001). There was no significant difference in the rate of successful valve deployment (GA 97.2% vs non-GA 95.7%, p=0.104) and in the incidence of more than mild aortic regurgitation (AR) at the end of the procedure (GA 5.6% vs non-GA 7.0%, p=0.295). However, procedure time was longer (131±60 vs 121±60mins, p=0.002) and length of stay was greater (8.0±13.5 vs 5.7±5.5 days, p<0.001) for GA cases. 30-day and 1-year mortality rates did not differ between the GA and non-GA cases. After propensity matching, these results remained unchanged. A second propensity analysis (adjusted for mode of anaesthesia) did not show an association between use of TOE and rate of successful valve deployment or frequency of significant AR. Neither was TOE associated with a longer procedural time or greater length of stay.ConclusionProcedure outcome, and 30-day and 1-year mortality are not influenced by mode of anaesthesia. However, GA is associated with longer procedure duration and greater length of stay.

Quantifying the Impact of Care Fragmentation on Outcomes After Transcatheter Aortic Valve Implantation

2020 ◽  
Vol 128 ◽  
pp. 113-119
Author(s):  
Sameer A. Hirji ◽  
Cheryl K. Zogg ◽  
Muthiah Vaduganathan ◽  
Spencer Kiehm ◽  
Edward D. Percy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
The Impact ◽  
Care Fragmentation

Abstract 15761: New Onset Atrial Fibrillation After Transcatheter Aortic Valve Implantation: A Pooled Meta-Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Arun Kanmanthareddy ◽  
Madhu Reddy ◽  
Venkata S Koripalli ◽  
Avanija Buddam ◽  
Nivedita Adabala ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Meta Analysis ◽  
Mortality Data ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
The Impact ◽  
New Onset

Introduction: Atrial fibrillation (AF) after cardiac surgery is associated with increased morbidity and mortality. Data comparing the occurrence of AF after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) is unknown. Methods: We identified all studies reporting outcomes after TAVI in all available electronic databases. Meta-analysis of all the studies was performed using random effects model to a) evaluate the incidence of AF and b) compare the incidence of AF between TAVI and SAVR. Results: The incidence of AF was reported in 7 studies, 5 prospective observational studies and 2 randomized controlled studies. The cumulative event rate for new onset AF at 30 days after TAVI was 0.1 (95% CI; 0.06 -0.17). Three studies reported incidence of AF after TAVI and SAVR. The odds ratio (OR) of developing new onset AF with TAVI compared to SAVR was 0.3 (95% CI; 0.10 - 0.88) at 30 days. One year outcome of new onset AF was reported in only two studies. Although, the incidence of AF was lower in the TAVI group, this did not reach statistical significance (OR 0.7, 95% CI; 0.46 -1.07). Conclusion: The incidence of new onset AF after TAVI is 10% within the first 30 days. This risk is 70% lower in patients undergoing TAVI compared to SAVR. The impact of AF after TAVI in terms of stroke, mortality and future recurrences of AF are unknown. Further studies are therefore necessary to study these outcomes.

scholarly journals Clinical process optimization of transfemoral transcatheter aortic valve implantation

2020 ◽  
Author(s):  
Julia Lortz ◽  
Tobias Peter Lortz ◽  
Laura Johannsen ◽  
Christos Rammos ◽  
Martin Steinmetz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Transcatheter Aortic Valve Implantation ◽  
Time Range ◽  
Major Goal ◽  
Clinical Process ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Prolonged Hospital ◽  
Valve Implantation

Background: The avoidance of prolonged hospital stay is a major goal in the management of transcatheter aortic valve implantation (TAVI) – medically and economically. Materials & methods: We compared the time range of the preprocedural length of stay in 2014/2015 with 2016/2017, after the implementation of the TAVI coordinator in 2016. This included restructured pathways for screening and pre-interventional diagnosis, performed examinations during the inpatient stay and major outcome variables. Results: After 2016, we observed a significant reduction in preprocedural length of stay (admission to procedure) compared with 2014/2015 (11.3 ± 7.9 vs 7.5 ± 5.6 days, p = 0.001). There was no difference in other major outcome variables. Conclusion: The introduction of the TAVI coordinator caused a shortening of preprocedural length of stay.

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