Transcatheter aortic valve implantation (TAVI) varies considerably in terms of the procedural approach taken and the hospital length of stay (LoS); both directly affect the cost of care. Our coronary and standard cardiology unit aimed to simplify TAVI (and thus shorten the LoS) while maintaining safety. A shorter LoS would also reduce the burden on hospital resources and free up beds for other patients. Data on 214 consecutive patients undergoing TAVI at a single centre between April 2018 and March 2021 were retrospectively collected. A simplified protocol was implemented in January 2020; patients were stratified by whether they underwent TAVI before or after simplification. All procedural phases were simplified. For cost comparison purposes, the LoS was defined as the number of hospitalization days from admission to discharge. The total hospitalization cost was the sum of the direct and indirect (including reallocated overhead) costs. The LoS fell significantly (by 36%) after TAVI simplification. The times in the coronary care unit (CCU) and standard cardiac unit (SCU) also fell significantly (by 33% and 37% respectively). Patients in the simplified TAVI group were discharged, on average, 6 days after admission. The CCU costs decreased by 31% and the SCU costs by 39%. Transcatheter aortic valve implantation simplification did not compromise safety. Indeed, patients who underwent the simplified procedure seemed to develop fewer complications, especially bleeding. Transcatheter aortic valve implantation simplification significantly reduced the LoS and other costs without compromising patient safety.

Department of Cardiology University Hospital Královské Vinohrady and 3rd Faculty of Medicine Charles University Šrobárova 50 Prague 10 100 34 Czech Republic

Medtronic Czechia Partner in the INTERCARDIS Project Prosecká 66 Prague 19000 Czech Republic

See more in PubMed

Vahl TP, Kodali SK, Leon MB.. Transcatheter aortic valve replacement 2016: a modern-day “through the looking-glass” adventure. J Am Coll Cardiol 2016;67:1472–1487. PubMed

Cost-comparison of third generation transcatheter aortic valve implantation (TAVI) devices in the German Health Care System | Elsevier Enhanced Reader [Internet]. Available at: https://reader.elsevier.com/reader/sd/pii/S0167527318335824?token=F2F60C7CF81ED27ACB8B6305589159C76DACECA205FDF5A6A6118EEDEB30F10FA5536C5B3A8000D3E6D4451005847DB5&originRegion=eu-west-1&originCreation=20210927085602 (accessed 27 September 2021). PubMed

Sangaraju S, Cox I, Dalrymple-Hay M, Lloyd C, Suresh V, Riches T, Melhuish S, Asopa S, Newcombe S, Deutsch C, Bramlage P.. Effect of procedural refinement of transfemoral transcatheter aortic valve implantation on outcomes and costs: a single-centre retrospective study. Open Heart 2019;6:e001064. PubMed PMC

Chopra M, Luk NHV, De Backer O, Søndergaard L.. Simplification and optimization of transcatheter aortic valve implantation—fast-track course without compromising safety and efficacy. BMC Cardiovasc Disord 2018;18:231. PubMed PMC

Cho J, Kim U.. Recent updates in transcatheter aortic valve implantation. Yeungnam Univ J Med 2018;35:17–26. PubMed PMC

Akodad M, Lefèvre T.. TAVI: simplification is the ultimate sophistication. Front Cardiovasc Med 2018;5:96. PubMed PMC

Durand E, Eltchaninoff H, Canville A, Bouhzam N, Godin M, Tron C, Rodriguez C, Litzler P-Y, Bauer F, Cribier A.. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis. Am J Cardiol 2015;115:1116–1122. PubMed

Noad RL, Johnston N, McKinley A, Dougherty M, Nzewi OC, Jeganathan R, Manoharan G, Spence MS.. A pathway to earlier discharge following TAVI: assessment of safety and resource utilization. Catheter Cardiovasc Interv 2016;87:134–142. PubMed

Serletis-Bizios A, Durand E, Cellier G, Tron C, Bauer F, Glinel B, Dacher J-N, Cribier A, Eltchaninoff H.. A prospective analysis of early discharge after transfemoral transcatheter aortic valve implantation. Am J Cardiol 2016;118:866–872. PubMed

Lauck SB, Wood DA, Baumbusch J, Kwon J-Y, Stub D, Achtem L, Blanke P, Boone RH, Cheung A, Dvir D, Gibson JA, Lee B, Leipsic J, Moss R, Perlman G, Polderman J, Ramanathan K, Ye J, Webb JG.. Vancouver transcatheter aortic valve replacement clinical pathway. Circ Cardiovasc Qual Outcomes 2016;9:312–321. PubMed

Lauck SB, Baron SJ, Sathananthan J, Murdoch D, Webb JG, Genereux P, Kodali SK, Reynolds M, Thompson C, Clancy S, Thourani VH, Wood DA, Cohen DJ.. Exploring the reduction in hospitalization costs associated with next-day discharge following transfemoral transcatheter aortic valve replacement in the United States. Struct Heart 2019;3:423–430.

Minimalist Approaches to TAVR: Options and Implications [Internet]. American College of Cardiology. Available at: https://www.acc.org/latest-in-cardiology/articles/2020/03/31/09/48/http%3a%2f%2fwww.acc.org%2flatest-in-cardiology%2farticles%2f2020%2f03%2f31%2f09%2f48%2fminimalist-approaches-to-tavr (accessed 15 November 2021).

Petronio AS, Giannini C, De Carlo M, Bedogni F, Colombo A, Tamburino C, et al.Anaesthetic management of transcatheter aortic valve implantation: results from the Italian CoreValve registry. EuroIntervention 2016;12:381–388. PubMed

Stortecky S, Franzone A, Heg D, Tueller D, Noble S, Pilgrim T, Jeger R, Toggweiler S, Ferrari E, Nietlispach F, Taramasso M, Maisano F, Grünenfelder J, Muller O, Huber C, Roffi M, Carrel T, Wenaweser P, Windecker S.. Temporal trends in adoption and outcomes of transcatheter aortic valve implantation: a SwissTAVI Registry analysis. Eur Heart J Qual Care Clin Outcomes 2019;5:242–251. PubMed

Frei A, Adamopoulos D, Mller H, Walder B, Perrin N, Reynaud T, Ho S, Roffi M, Mach F, Licker M-J, Noble S.. Determinants of hospital length of stay after transcatheter aortic valve implantation with self-expanding prostheses: a prospective, single centre observational study. Swiss Med Wkly 2019;149:w20095. PubMed

Osnabrugge RLJ, Head SJ, Genders TSS, Van Mieghem NM, De Jaegere PPT, van der Boon RMA, Kerkvliet JM, Kalesan B, Bogers AJJC, Kappetein AP, Hunink MGM.. Costs of transcatheter versus surgical aortic valve replacement in intermediate-risk patients. Ann Thorac Surg 2012;94:1954–1960. PubMed

Di Mario C, Eltchaninoff H, Moat N, Goicolea J, Ussia GP, Kala P, et al.The 2011-12 pilot European Sentinel Registry of Transcatheter Aortic Valve Implantation: in-hospital results in 4,571 patients. EuroIntervention 2013;8:1362–1371. PubMed

Wood DA, Lauck SB, Cairns JA, Humphries KH, Cook R, Welsh R, Leipsic J, Genereux P, Moss R, Jue J, Blanke P, Cheung A, Ye J, Dvir D, Umedaly H, Klein R, Rondi K, Poulter R, Stub D, Barbanti M, Fahmy P, Htun N, Murdoch D, Prakash R, Barker M, Nickel K, Thakkar J, Sathananthan J, Tyrell B, Al-Qoofi F, Velianou JL, Natarajan MK, Wijeysundera HC, Radhakrishnan S, Horlick E, Osten M, Buller C, Peterson M, Asgar A, Palisaitis D, Masson J-B, Kodali S, Nazif T, Thourani V, Babaliaros VC, Cohen DJ, Park JE, Leon MB, Webb JG.. The Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) clinical pathway facilitates safe next-day discharge home at low-, medium-, and high-volume transfemoral transcatheter aortic valve replacement centers: the 3M TAVR study. JACC Cardiovasc Interv 2019;12:459–469. PubMed

Karyofillis P, Kostopoulou A, Thomopoulou S, Habibi M, Livanis E, Karavolias G, et al.Conduction abnormalities after transcatheter aortic valve implantation. J Geriatr Cardiol 2018;15:105–112. PubMed PMC

Rück A, Saleh N, Glaser N.. Outcomes following permanent pacemaker implantation after transcatheter aortic valve replacement. JACC Cardiovasc Interv 2021;14:2173–2181. PubMed

Mangieri A, Montalto C, Poletti E, Sticchi A, Crimi G, Giannini F, Latib A, Capodanno D, Colombo A.. Thrombotic versus bleeding risk after transcatheter aortic valve replacement: JACC review topic of the week. J Am Coll Cardiol 2019;74:2088–2101. PubMed

Ranasinghe MP, Peter K, McFadyen JD.. Thromboembolic and bleeding complications in transcatheter aortic valve implantation: insights on mechanisms, prophylaxis and therapy. J Clin Med 2019;8:280. PubMed PMC

Nijenhuis VJ, Brouwer J, Delewi R, Hermanides RS, Holvoet W, Dubois CLF, Frambach P, De Bruyne B, van Houwelingen GK, Van Der Heyden JAS, Toušek P, van der Kley F, Buysschaert I, Schotborgh CE, Ferdinande B, van der Harst P, Roosen J, Peper J, Thielen FWF, Veenstra L, Chan Pin Yin DRPP, Swaans MJ, Rensing BJWM, van 't Hof AWJ, Timmers L, Kelder JC, Stella PR, Baan J, Ten Berg JM.. Anticoagulation with or without clopidogrel after transcatheter aortic-valve implantation. N Engl J Med 2020;382:1696–1707. PubMed