BACKGROUND AND AIMS: There is significant potential to streamline the clinical pathway for patients undergoing transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate the effect of implementing BENCHMARK best practices on the efficiency and safety of TAVI in 28 sites in 7 European countries. METHODS: This was a study of patients with severe symptomatic aortic stenosis (AS) undergoing TAVI with balloon-expandable valves before and after implementation of BENCHMARK best practices. Principal objectives were to reduce hospital length of stay (LoS) and duration of intensive care stay. Secondary objective was to document patient safety. RESULTS: Between January 2020 and March 2023, 897 patients were documented prior to and 1491 patients after the implementation of BENCHMARK practices. Patient characteristics were consistent with a known older TAVI population and only minor differences. Mean LoS was reduced from 7.7 ± 7.0 to 5.8 ± 5.6 days (median 6 vs. 4 days; P < .001). Duration of intensive care was reduced from 1.8 to 1.3 days (median 1.1 vs. 0.9 days; P < .001). Adoption of peri-procedure best practices led to increased use of local anaesthesia (96.1% vs. 84.3%; P < .001) and decreased procedure (median 47 vs. 60 min; P < .001) and intervention times (85 vs. 95 min; P < .001). Thirty-day patient safety did not appear to be compromised with no differences in all-cause mortality (0.6% in both groups combined), stroke/transient ischaemic attack (1.4%), life-threatening bleeding (1.3%), stage 2/3 acute kidney injury (0.7%), and valve-related readmission (1.2%). CONCLUSIONS: Broad implementation of BENCHMARK practices contributes to improving efficiency of TAVI pathway reducing LoS and costs without compromising patient safety.

Cardiac Center IKEM Prague Prague Czech Republic

Cardiology Besancon Regional University Hospital Center Besancon France

Cardiology Centro Cardiologico Monzino Milan Italy

Cardiology Department Hospital Regional Universitario de Málaga Malaga Spain

Cardiology Department Hospital Sindelfingen Böblingen Sindelfingen Germany

Cardiology Department James Cook University Hospital Middlesbrough UK

Cardiology Department Mater Private Network Dublin Ireland

Cardiology Department Montpellier University Hospital Montpellier University Montpellier France

Cardiology Department University Hospital Son Espases Palma de Mallorca Spain

Cardiology Polyclinique Du Bois Lille France

Centre for Cardiovascular Innovation University of British Columbia Vancouver BC Canada

Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Madrid Spain

Department de Cardiologie Hôpital de Pitié Salpêtrière AP HP Paris France

Department for Cardiovascular Surgery Artemed Klinikum München München Germany

Department of Cardiology and Pulmonology Georg August University Göttingen Germany

Department of Cardiology Centre Hospitalier Régional Universitaire de Tours Hôpital Trousseau Tours France

Department of Cardiology Hospital Floridsdorf Vienna Austria

Department of Cardiology Institut Mutualiste Montsouris Paris France

Department of Cardiology Kerckhoff Klinik Bad Nauheim Germany

Department of Cardiology The Clinique de l'Infirmerie Protestante Lyon France

Department of Cardiology Univ Rouen Normandie Inserm U1096 CHU Rouen Rouen France

Department of Cardiology University Medicine Göttingen Heart Center Göttingen Germany

Department of Cardiology University of Bologna Policlinico S Orsola Malpighi Bologna Italy

Department of Cardiology University of Medicine and Pharmacy Carol Davila Bucharest Romania

Department of Cardiothoracic Surgery Heart Center Faculty of Medicine University Hospital of Cologne Cologne Germany

Department of Internal Medicine 3 Arnold Heller Strasse 3 Haus K3 Kiel 24105 Germany

Department of Internal Medicine 3 Cardiology University Hospital St Pölten St Pölten Austria

Department of Internal Medicine 3 German Centre for Cardiovascular Research partner site Hamburg Kiel Lübeck Arnold Heller Strasse 3 Haus K3 Kiel 24105 Germany

Department of Interventional Cardiology Hôpital Saint Joseph Marseille France

Department of Medicine 3 University of Heidelberg German Centre for Cardiovascular Research Heilderberg Germany

Division of Cardiology Department of Cardiovascular Surgery L'Ospedale S Giuseppe Moscati di Avellino Avellino Italy

Edwards Lifesciences Nyon Switzerland

Edwards Lifesciences Prague Czech Republic

Heart Diseases Institute Bellvitge University Hospital IDIBELL University of Barcelona Barcelona Spain

Institute for Pharmacology and Preventive Medicine Cloppenburg Germany

Instituto Cardiovascular Hospital Clínico San Carlos Instituto de Investigación Sanitaria del Hospital Clínico San Carlos Madrid Spain

Internal Medicine 3 Cardiology Angiology and Internal Intensive Care Medicine University Hospital of Saarland Homburg Germany

Karl Landsteiner Institute for Cardiovascular and Critical Care Research Vienna Vienna Austria

Medical Department 3 Heart Center Trier Krankenhaus der Barmherzigen Brüder Trier Germany

Servicio de Cardiología Hospital de la Santa Creu i Sant Pau Instituto de Investigación Biomédica Sant Pau Barcelona Spain

Structural Interventional Cardiology Division Department of Clinical and Experimental Medicine Careggi University Hospital Florence Italy

Struttura Complessa of Cardiology Ospedale Mauriziano Torino Italy

Université de Rennes 1 CHU Rennes Service de Cardiologie Inserm LTSI U1099 Rennes France

doi: 10.1093/eurheartj/ehae174 PubMed

Zobrazit více v PubMed

Vendrik  J, Vlastra  W, van Mourik  MS, Delewi  R, Beijk  MA, Lemkes  J, et al.  Early mobilisation after transfemoral transcatheter aortic valve implantation: results of the MobiTAVI trial. Neth Heart J  2020;28:240–8. 10.1007/s12471-020-01374-5 PubMed DOI PMC

Lauck  SB, Wood  DA, Baumbusch  J, Kwon  JY, Stub  D, Achtem  L, et al.  Vancouver transcatheter aortic valve replacement clinical pathway: minimalist approach, standardized care, and discharge criteria to reduce length of stay. Circ Cardiovasc Qual Outcomes  2016;9:312–21. 10.1161/CIRCOUTCOMES.115.002541 PubMed DOI

Barbanti  M, Capranzano  P, Ohno  Y, Attizzani  GF, Gulino  S, Imme  S, et al.  Early discharge after transfemoral transcatheter aortic valve implantation. Heart  2015;101:1485–90. 10.1136/heartjnl-2014-307351 PubMed DOI

Aldalati  O, Keshavarzi  F, Kaura  A, Byrne  J, Eskandari  M, Deshpande  R, et al.  Factors associated with safe early discharge after transcatheter aortic valve implantation. Cardiol J  2018;25:14–23. 10.5603/CJ.a2017.0087 PubMed DOI

Alkhalil  A, Lamba  H, Deo  S, Bezerra  HG, Patel  SM, Markowitz  A, et al.  Safety of shorter length of hospital stay for patients undergoing minimalist transcatheter aortic valve replacement. Catheter Cardiovasc Interv  2018;91:345–53. 10.1002/ccd.27230 PubMed DOI

Mallikethi-Reddy  S, Akintoye  E, Telila  T, Sudhakar  R, Jagadeesh  K, Briasoulis  A, et al.  Transcatheter aortic valve implantation in the United States: predictors of early hospital discharge. J Interv Cardiol  2017;30:149–55. 10.1111/joic.12373 PubMed DOI

Kamioka  N, Wells  J, Keegan  P, Lerakis  S, Binongo  J, Corrigan  F, et al.  Predictors and clinical outcomes of next-day discharge after minimalist transfemoral transcatheter aortic valve replacement. JACC Cardiovasc Interv  2018;11:107–15. 10.1016/j.jcin.2017.10.021 PubMed DOI

Durand  E, Eltchaninoff  H, Canville  A, Bouhzam  N, Godin  M, Tron  C, et al.  Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis. Am J Cardiol  2015;115:1116–22. 10.1016/j.amjcard.2015.01.546 PubMed DOI

Serletis-Bizios  A, Durand  E, Cellier  G, Tron  C, Bauer  F, Glinel  B, et al.  A prospective analysis of early discharge after transfemoral transcatheter aortic valve implantation. Am J Cardiol  2016;118:866–72. 10.1016/j.amjcard.2016.06.035 PubMed DOI

Wood  DA, Lauck  SB, Cairns  JA, Humphries  KH, Cook  R, Welsh  R, et al.  The Vancouver 3 M (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 3 M TAVR study. JACC Cardiovasc Interv  2019;12:459–69. 10.1016/j.jcin.2018.12.020 PubMed DOI

Lauck  SB, Sathananthan  J, Park  J, Achtem  L, Smith  A, Keegan  P, et al.  Post-procedure protocol to facilitate next-day discharge: results of the multidisciplinary, multimodality but minimalist TAVR study. Catheter Cardiovasc Interv  2020;96:450–8. 10.1002/ccd.28617 PubMed DOI

Butala  NM, Wood  DA, Li  H, Chinnakondepalli  K, Lauck  SB, Sathananthan  J, et al.  Economics of minimalist transcatheter aortic valve replacement: results from the 3M-TAVR economic study. Circ Cardiovasc Interv  2022;15:e012168. 10.1161/CIRCINTERVENTIONS.122.012168 PubMed DOI PMC

Barbanti  M, van Mourik  MS, Spence  MS, Iacovelli  F, Martinelli  GL, Muir  DF, et al.  Optimising patient discharge management after transfemoral transcatheter aortic valve implantation: the multicentre European FAST-TAVI trial. EuroIntervention  2019;15:147–54. 10.4244/EIJ-D-18-01197 PubMed DOI

Barbanti  M, Baan  J, Spence  MS, Iacovelli  F, Martinelli  GL, Saia  F, et al.  Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation—rationale and design of the FAST-TAVI registry. BMC Cardiovasc Disord  2017;17:259. 10.1186/s12872-017-0693-0 PubMed DOI PMC

Lauck  S, Forman  J, Borregaard  B, Sathananthan  J, Achtem  L, McCalmont  G, et al.  Facilitating transcatheter aortic valve implantation in the era of COVID-19: recommendations for programmes. Eur J Cardiovasc Nurs  2020;19:537–44. 10.1177/1474515120934057 PubMed DOI PMC

Bohmann  K, Burgdorf  C, Zeus  T, Joner  M, Alvarez  H, Berning  KL, et al.  The COORDINATE pilot study: impact of a transcatheter aortic valve coordinator program on hospital and patient outcomes. J Clin Med  2022;11:1205. 10.3390/jcm11051205 PubMed DOI PMC

McCalmont  G, Durand  E, Lauck  S, Muir  DF, Spence  MS, Vasa-Nicotera  M, et al.  Setting a benchmark for resource utilization and quality of care in patients undergoing transcatheter aortic valve implantation in Europe-rationale and design of the international BENCHMARK registry. Clin Cardiol  2021;44:1344–53. 10.1002/clc.23711 PubMed DOI PMC

Katz  S, Ford  AB, Moskowitz  RW, Jackson  BA, Jaffe  MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA  1963;185:914–9. 10.1001/jama.1963.03060120024016 PubMed DOI

Folstein  MF, Folstein  SE, McHugh  PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res  1975;12:189–98. 10.1016/0022-3956(75)90026-6 PubMed DOI

Frank  D, Kennon  S, Bonaros  N, Stastny  L, Romano  M, Lefevre  T, et al.  Aortic valve replacement: validation of the Toronto Aortic Stenosis Quality of Life Questionnaire. ESC Heart Fail  2021;8:270–9. 10.1002/ehf2.12961 PubMed DOI PMC

Lortz  J, Lortz  TP, Johannsen  L, Rammos  C, Steinmetz  M, Lind  A, et al.  Clinical process optimization of transfemoral transcatheter aortic valve implantation. Future Cardiol  2021;17:321–7. 10.2217/fca-2020-0010 PubMed DOI

Durand  E, Beziau-Gasnier  D, Michel  M, Iung  B, Tchetche  D, Bonnet  G, et al. Reducing length of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial. Eur Heart J  2024;45:952–62. 10.1093/eurheartj/ehae081 PubMed DOI

Reddavid  C, Costa  G, Valvo  R, Criscione  E, Strazzieri  O, Motta  S, et al.  Transcatheter aortic valve implantation during COVID-19 pandemic: an optimized model to relieve healthcare system overload. Int J Cardiol  2022;352:190–4. 10.1016/j.ijcard.2022.01.038 PubMed DOI PMC

Valdebenito  M, Massalha  E, Barbash  IM, Maor  E, Fefer  P, Guetta  V, et al.  Transcatheter aortic valve implantation during the COVID-19 pandemic. Am J Cardiol  2021;145:97–101. 10.1016/j.amjcard.2020.12.086 PubMed DOI PMC

Tan  J, Teoh  TK, Ivanova  J, Jadhav  S, Varcoe  R, Baig  K, et al.  17 the impact of the COVID-19 pandemic on transcatheter aortic valve implantation (TAVI) services in the United Kingdom: a tertiary centre experience. Heart  2021;107:A13–4. 10.1136/heartjnl-2021-BCS.17 DOI

Ryffel  C, Alaour  B, Tomii  D, Okuno  T, Temperli  F, Bruno  J, et al.  Impact of COVID-19 surge periods on clinical outcomes of transcatheter aortic valve implantation. Am J Cardiol  2023;204:32–9. 10.1016/j.amjcard.2023.07.072 PubMed DOI

Joseph  J, Kotronias  RA, Estrin-Serlui  T, Cahill  TJ, Kharbanda  RK, Newton  JD, et al.  Safety and operational efficiency of restructuring and redeploying a transcatheter aortic valve replacement service during the COVID-19 pandemic: the Oxford experience. Cardiovasc Revasc Med  2021;31:26–31. 10.1016/j.carrev.2020.12.002 PubMed DOI PMC

Avvedimento  M, Real  C, Nuche  J, Farjat-Pasos  J, Galhardo  A, Trinh  KH, et al.  Incidence, predictors, and prognostic impact of bleeding events after TAVR according to VARC-3 criteria. JACC Cardiovasc Interv  2023;16:2262–74. 10.1016/j.jcin.2023.07.005 PubMed DOI

Généreux  P, Piazza  N, Alu Maria  C, Nazif  T, Hahn Rebecca  T, Pibarot  P, et al.  Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. J Am Coll Cardiol  2021;77:2717–46. 10.1016/j.jacc.2021.02.038 PubMed DOI

Lauck  SB, Arnold  SV, Borregaard  B, Sathananthan  J, Humphries  KH, Baron  SJ, et al.  Very early changes in quality of life after transcatheter aortic valve replacement: results from the 3 M TAVR trial. Cardiovasc Revasc Med  2020;21:1573–8. 10.1016/j.carrev.2020.05.044 PubMed DOI

Arnold  SV, Spertus  JA, Vemulapalli  S, Li  Z, Matsouaka  RA, Baron  SJ, et al.  Quality-of-life outcomes after transcatheter aortic valve replacement in an unselected population: a report from the STS/ACC Transcatheter Valve Therapy Registry. JAMA Cardiol  2017;2:409–16. 10.1001/jamacardio.2016.5302 PubMed DOI PMC

Bona  V, Khawaja  MZ, Bapat  V, Young  C, Hancock  J, Redwood  S, et al.  Early and late changes in quality of life following transcatheter aortic valve implantation using the transfemoral and transapical approaches. EuroIntervention  2015;11:221–9. 10.4244/EIJV11I2A41 PubMed DOI

Lauck  SB, Yu  M, Ding  L, Hardiman  S, Wong  D, Sathananthan  J, et al.  Quality-of-life outcomes after transcatheter aortic valve implantation in a “real world” population: insights from a prospective Canadian database. CJC Open  2021;3:1033–42. 10.1016/j.cjco.2021.04.006 PubMed DOI PMC

Krishnaswamy  A, Kaur  S, Isogai  T, Zhou  L, Shekhar  S, Yun  J, et al.  Minimalist mitral valve-in-valve replacement using conscious sedation and intracardiac echocardiography is feasible and safe. JACC Cardiovasc Interv  2022;15:1288–90. 10.1016/j.jcin.2022.03.022 PubMed DOI

Steeds  RP, Lutz  M, Thambyrajah  J, Serra  A, Schulz  E, Maly  J, et al.  Facilitated data relay and effects on treatment of severe aortic stenosis in Europe. J Am Heart Assoc  2019;8:e013160. 10.1161/JAHA.119.013160 PubMed DOI PMC