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

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001064
Author(s):  
Sivasankar Sangaraju ◽  
Ian Cox ◽  
Malcolm Dalrymple-Hay ◽  
Clinton Lloyd ◽  
Venkatesan Suresh ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Transcatheter Aortic Valve Implantation ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Transcatheter Aortic Valve ◽  
The Mean ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Transfemoral Tavi

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.

scholarly journals Balloon-Expandable versus Self-Expandable Valves in Transcatheter Aortic Valve Implantation: Complications and Outcomes from a Large International Patient Cohort

2021 ◽  
Vol 10 (17) ◽  
pp. 4005
Author(s):  
Astrid C. van Nieuwkerk ◽  
Raquel B Santos ◽  
Leire Andraka ◽  
Didier Tchetche ◽  
Fabio S. de Brito ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Transcatheter Aortic Valve ◽  
The Mean ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation ◽  
Transfemoral Tavi

Background: Both balloon-expandable (BE) and self-expandable (SE) valves for transcatheter aortic valve implantation (TAVI) are broadly used in clinical practice. However, adequately powered randomized controlled trials comparing these two valve designs are lacking. Methods: The CENTER-study included 12,381 patients undergoing transfemoral TAVI. Patients undergoing TAVI with a BE-valve (n = 4096) were compared to patients undergoing TAVI with an SE-valve (n = 4096) after propensity score matching. Clinical outcomes including one-year mortality and stroke rates were assessed. Results: In the matched population of n = 5410 patients, the mean age was 81 ± 3 years, 60% was female, and the STS-PROM predicted 30-day mortality was 6.2% (IQR 4.0–12.4). One-year mortality was not different between patients treated with BE- or SE-valves (BE: 16.4% vs. SE: 17.0%, Relative Risk 1.04, 95%CI 0.02–1.21, p = 0.57). One-year stroke rates were also comparable (BE: 4.9% vs. SE: 5.3%, RR 1.09, 95%CI 0.86–1.37, p = 0.48). Conclusion: This study suggests that one-year mortality and stroke rates were comparable in patients with severe aortic valve stenosis undergoing TAVI with either BE or SE-valves.

scholarly journals Transcatheter Aortic Valve Implantation Without General Anaesthetic

2011 ◽  
Vol 9 (2) ◽  
pp. 130
Author(s):  
Simon Kennon ◽  
Zhan Lim ◽  
◽  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Transcatheter Aortic Valve Implantation ◽  
Length Of Hospital Stay ◽  
General Anaesthetic ◽  
Patient Anxiety ◽  
Single Centre ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) procedures are increasingly being performed under local anaesthetic, generally with sedation. Operators hope this will reduce mortality, morbidity and length of hospital stay. A general anaesthetic (GA), however, although involving intrinsic risk, permits transoesophageal echocardiogram (TOE) imaging throughout a procedure as well as eliminating patient anxiety, pain and movement. This article reviews the published literature, all single-centre experiences, comparing TAVI procedures performed with and without a GA. Procedures performed without GA are generally shorter with reduced length of stay compared with those performed under GA. There is no evidence of any difference in 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.

Midterm Outcomes after Transcatheter Aortic Valve Implantation

2014 ◽  
Vol 9 (5) ◽  
pp. 343-348 ◽  
Author(s):  
Shahram Lotfi ◽  
Guido Dohmen ◽  
Andreas Götzenich ◽  
Marcus Haushofer ◽  
Jan Wilhelm Spillner ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Logistic Euroscore ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
The Mean ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Objective Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for high-risk or nonoperable patients with severe symptomatic aortic valve stenosis. The best known and most frequently implanted prostheses are the CoreValve and SAPIEN prostheses. We report our experiences and analyze the results of our TAVI program. Methods A total of 357 patients underwent transfemoral (TF) and transapical (TA) TAVI in our center between January 2008 and October 2012. The procedure was performed in 190 patients with CoreValve, in 155 patients with SAPIEN, and in 12 patients with ACURATE TA prostheses. Transfemoral access was used in 190 patients. In 167 patients, TA access was used. The mean age was 80.2 ± 6.4 years. All patients were nonoperable or had a high risk for a conventional aortic valve replacement. The mean logistic EuroSCORE I was 25.92 ± 14.51%. The TF/CoreValve (190 patients) and TA/SAPIEN (155 patients) groups showed significant difference in the patients’ mean age (81.7 ± 6.3 years vs. 79.5 ± 6.6 years, P = 0.002) and in mean logistic EuroSCORE I (22.16 ± 13.05% vs. 31.04 ± 16.40, P < 0.001). Results The overall 30-day mortality (357 patients) was 9.80% (TF, 8.42%; TA, 11.37%); overall 1-year mortality (275 patients), 21.45% (TF, 23.74%; TA, 19.12%); overall 2-year mortality (199 patients), 29.15% (TF, 35.96%; TA, 23.64%); overall 3-year mortality (133 patients), 37.59% (TF, 43.86%; TA, 32.89%); and overall 4-year mortality (38 patients), 39.47% (TF, 45%; TA, 33.33%). The rate of pacemaker implantation after TAVI was significantly higher in the CoreValve group than in the SAPIEN group: 44.74% (85/190 patients) versus 6.45% (10/155 patients), P < 0.001. Stroke rate was higher in the TF-CoreValve group than in the TA-SAPIEN group: 4.21% versus 0.64%, P = 0.045. Conclusions Outcomes after TAVI were, in our population of nonoperable and high-risk patients, encouraging. The differences in midterm outcomes between the TF-CoreValve TAVI and the TA-SAPIEN TAVI were not significant.

Single-Center Experience and Short-term Outcome with the JenaValve: A Second-Generation Transapical Transcatheter Aortic Valve Implantation Device

2014 ◽  
Vol 9 (5) ◽  
pp. 368-374 ◽  
Author(s):  
Oliver Reuthebuch ◽  
Devdas Thomas Inderbitzin ◽  
Florian Ruter ◽  
Raban Jeger ◽  
Christoph Kaiser ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Second Generation ◽  
Short Term ◽  
Term Outcome ◽  
Transcatheter Aortic Valve ◽  
Short Term Outcome ◽  
The Mean ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Objective We present the post-CE(Conformité Européenne)-mark single-center implantation experience and short-term outcome with the second-generation transapical JenaValve transcatheter aortic valve implantation system. Methods Patients [N = 27; 9 women; mean (SD) age, 80.3 (5.5) years] were operated on between November 2011 and August 2012. Via a transapical approach, the valve was positioned, in some cases, repositioned, and finally implanted. All data were collected during the hospital stay. Results The implantation success rate was 100%; the mean (SD) operation time was 124.7 (43.2) minutes; and the size of the implanted prosthesis was 23 mm (n = 6), 25 mm (n = 14), and 27 mm (n = 7). The in-hospital major adverse cardiac and cerebrovascular events were as follows: intraoperative resuscitation with subsequent aortic rupture (n = 1), postoperative hemorrhage needing revision (n = 1), myocardial infarction (n = 1), atrioventricular block needing a definitive pacemaker (n = 1), new-onset renal failure needing hemodialysis (n = 1), and stroke (n = 1). The 30-day mortality was 11.1% (n = 3). The mean (SD) intensive care unit/total stay was 2.2 (1.7)/11.7 (7.9) days. Postoperative echocardiography [day 6.7 (4.8)] revealed residual para-valvular leakage of trace to grade 1 in 12 patients (44.5%) and no leakage in 15 patients, with a mean (SD) transvalvular pressure gradient of 11.6 (5.6) mm Hg with significant reduction by 36.0 (17.7) mm Hg ( P = 0.0001, Wilcoxon signed rank test). Conclusions This second-generation repositionable transcatheter aortic valve implantation device could safely and successfully be implanted with a fast learning curve, significant reduction in pressure gradients, overall clinical improvement at discharge, as well as an acceptable morbidity and mortality rate in this highest-risk patient cohort.

Feasibility and safety of oversizing self-expandable valves for transcatheter aortic valve implantation, according to aortic annulus maximal diameter

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Jourdi ◽  
T.R Trimech ◽  
S Fradi ◽  
S Ghostine
Keyword(s):  
Aortic Valve ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Transcatheter Aortic Valve Implantation ◽  
Aortic Annulus ◽  
Control Group ◽  
Transcatheter Aortic Valve ◽  
Maximal Diameter ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) can lead to paravalvular leak (PVL) in 15% to 20% of cases, which remains an important prognostic factor and an independent predictor of mortality in short and long-term follow-up. Objectives To evaluate feasibility and safety of oversizing Medtronic Self-Expandable Valve (Dvalve), calculated according to the aortic annulus maximal diameter (Dmax), on the incidence of PVL and in-hospital mortality after TAVI. Methods We retrospectively analyzed the data of 610 patients treated with TAVI between January 2016 and December 2018. A group of 45 patients of the oversized group (October 2017 to December 2018) accordingly to the Dmax, when (Dvalve − Dmax) | &lt;2 mm in the absence of contraindication was compared to a control group of 213 patients whose prosthesis size had been chosen according to the aortic annulus perimeter (January 2016 to September 2017). Results In the “oversized” group, no patient had a significant PVL after TAVI compared with the control group (0% vs. 7.51%; p=0.041). Balloon post-dilatation was significantly less frequent in the “oversized” group (0% vs. 10.3%; p=0.012). Per-procedural irradiation and the average length of in-hospital stay were significantly lower (PDS = 2,296.05±1,667.94 cGy·mm2 vs. 4,568±1,352.84 cGy·mm2; p&lt;0.001; and 5.23±1.74 days vs. 6.33±3.23 days; p=0.029, respectively). No case of annulus rupture occurred in the “oversized” group. The incidences of high-degree atrioventricular block with definitive pacing and in-hospital mortality were similar between the two groups. Conclusion Oversizing the self-expandable valve, according to the aortic annulus maximal diameter, significantly reduced PVL after TAVI, balloon post-dilatation, per-procedural irradiation, and the length of hospital stay, without increasing the risk of mechanical, rhythmic, conductive and coronary occlusion complications. It does not increase the in-hospital mortality rate either. Randomized controlled trials are needed to establish a firm conclusion about its feasibility and safety. Funding Acknowledgement Type of funding source: None

scholarly journals Predictors of length of stay and duration of tracheal intubation after transcatheter aortic valve implantation

2017 ◽  
Vol 9 (4) ◽  
pp. 1012-1022
Author(s):  
Vasileios Patris ◽  
Konstantinos Giakoumidakis ◽  
Mihalis Argiriou ◽  
Katerina K. Naka ◽  
Efstratios Apostolakis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Tracheal Intubation ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals Internal Endoconduit Technique during Transcatheter Aortic Valve Implantation

2019 ◽  
Vol 08 (01) ◽  
pp. e5-e7
Author(s):  
Osamu Sakai ◽  
Katsuhiko Oka ◽  
Tomoya Inoue ◽  
Hitoshi Yaku
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Iliac Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Transfemoral Approach ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Transfemoral Tavi

AbstractThe transfemoral approach is the least invasive transcatheter aortic valve implantation (TAVI) approach, but the diameter of the iliofemoral arteries needs to exceed 5 mm. We report a case of limited access transfemoral TAVI by the “internal endoconduit technique,” which is well known as a safe and effective dilatational technique for thoracic endovascular aortic repair. Subsequently, we could deliver the device without iliac artery injury and we performed transfemoral TAVI.

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