A streamlined pathway for transcatheter aortic valve implantation: the BENCHMARK study
Por:
Frank, D, Durand, E, Lauck, S, Muir, DF, Spence, M, Vasa-Nicotera, M, Wood, D, Saia, F, Urbano-Carrillo, CA, Bouchayer, D, Iliescu, VA, Etienne, CS, Leclercq, F, Auffret, V, Asmarats, L, Di Mario, C, Veugeois, A, Maly, J, Schober, A, Nombela-Franco, L, Werner, N, Gomez-Hospital, JA, Mascherbauer, J, Musumeci, G, Meneveau, N, Meurice, T, Mahfoud, F, De Marco, F, Seidler, T, Leuschner, F, Joly, P, Collet, JP, Vogt, F, Di Lorenzo, E, Kuhn, E, Disdier, VP, Hachaturyan, V, Lueske, CM, Rakova, R, Wesselink, W, Bramlage, P, Mccalmont, G
Publicada:
30 mar 2024
Ahead of Print:
1 mar 2024
Resumen:
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.
Filiaciones:
Frank, D:
Univ Clin Ctr Schleswig Holstein UKSH, Dept Internal Med Cardiol Angiol & Intens Care Med, Arnold Heller Str 3,Haus K3, D-24105 Kiel, Germany
German Ctr Cardiovasc Res, Dept Internal Med Cardiol Angiol & Intens Care Med, Partner Site Hamburg Kiel Lubeck, Arnold Heller Str 3,Haus K3, D-24105 Kiel, Germany
Durand, E:
Univ Rouen Normandie, Dept Cardiol, Inserm U1096, CHU Rouen, Rouen, France
Lauck, S:
Univ British Columbia, Ctr Cardiovasc Innovat, Vancouver, BC, Canada
Muir, DF:
James Cook Univ Hosp, Dept Cardiol, Middlesbrough, England
Spence, M:
Mater Private Network, Dept Cardiol, Dublin, Ireland
Vasa-Nicotera, M:
Hosp Sindelfingen Boblingen, Dept Cardiol, Sindelfingen, Germany
Wood, D:
Univ British Columbia, Ctr Cardiovasc Innovat, Vancouver, BC, Canada
Saia, F:
Univ Bologna, Dept Cardiol, Policlin S Orsola Malpighi, Bologna, Italy
Urbano-Carrillo, CA:
Hosp Reg Univ Malaga, Cardiol Dept, Malaga, Spain
Bouchayer, D:
Clin Infirm Protestante, Dept Cardiol, Lyon, France
Iliescu, VA:
Univ Med & Pharm Carol Davila, Dept Cardiol, Bucharest, Romania
Etienne, CS:
Hop Trousseau, Ctr Hosp Reg Univ CHRU Tours, Dept Cardiol, Tours, France
Leclercq, F:
Montpellier Univ, Montpellier Univ Hosp, Cardiol Dept, Montpellier, France
Auffret, V:
Univ Rennes 1, CHU Rennes, Serv Cardiol, Inserm LTSI U1099, Rennes, France
Asmarats, L:
Hosp Santa Creu & Sant Pau, Serv Cardiol, Inst Invest Biomed St Pau, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc, CIBERCV, Madrid, Spain
Di Mario, C:
Careggi Univ Hosp, Dept Clin & Expt Med, Struct Intervent Cardiol Div, Florence, Italy
Veugeois, A:
Inst Mutualiste Montsouris, Dept Cardiol, Paris, France
Maly, J:
IKEM, Cardiac Ctr, Prague, Czech Republic
Schober, A:
Hosp Floridsdorf, Dept Cardiol, A-1210 Vienna, Austria
Karl Landsteiner Inst Cardiovasc & Crit Care Res V, Vienna, Austria
Nombela-Franco, L:
Hosp Clin San Carlos, Inst Invest Sanitaria Hosp Clin San Carlos IDISSC, Inst Cardiovasc, Madrid, Spain
Werner, N:
Krankenhaus Barmherzigen Bruder Trier, Heart Ctr Trier, Med Dept 3, Trier, Germany
Gomez-Hospital, JA:
Univ Barcelona, Heart Dis Inst, Bellvitge Univ Hosp IDIBELL, Barcelona, Spain
Mascherbauer, J:
Univ Hosp St Polten, Dept Internal Med Cardiol 3, St Polten, Austria
Musumeci, G:
Osped Mauriziano Umberto 1, Struttura Complessa Cardiol, Turin, Italy
Meneveau, N:
Besancon Reg Univ Hosp Ctr, Cardiol, Besancon, France
Meurice, T:
Polyclin Bois, Cardiol, Lille, France
Mahfoud, F:
Univ Hosp Saarland, Internal Med Cardiol Angiol & Internal Intens Care, Homburg, Germany
De Marco, F:
Ctr Cardiol Monzino, Cardiol, Milan, Italy
Seidler, T:
Georg August Univ, Dept Cardiol & Pulmonol, Gottingen, Germany
Univ Med Gottingen, Heart Ctr, Dept Cardiol, Gottingen, Germany
Kerckhoff Klin, Dept Cardiol, Bad Nauheim, Germany
Leuschner, F:
Heidelberg Univ, German Ctr Cardiovasc Res DZHK, Dept Med 3, Heilderberg, Germany
Joly, P:
Hop St Joseph, Dept Intervent Cardiol, Marseille, France
Collet, JP:
Hop La Pitie Salpetriere, AP HP, Dept Cardiol, Paris, France
Vogt, F:
Artemed Klinikum Munchen, Dept Cardiovasc Surg, Munich, Germany
Di Lorenzo, E:
Osped S Giuseppe Moscati Avellino, Dept Cardiovasc Surg, Div Cardiol, Avellino, Italy
Kuhn, E:
Univ Hosp Cologne, Fac Med, Heart Ctr, Dept Cardiothorac Surg, Cologne, Germany
Disdier, VP:
Univ Hosp Son Espases, Cardiol Dept, Palma De Mallorca, Spain
Hachaturyan, V:
Inst Pharmacol & Prevent Med, Cloppenburg, Germany
Lueske, CM:
Inst Pharmacol & Prevent Med, Cloppenburg, Germany
Wesselink, W:
Edwards Lifesci, Prague, Czech Republic
Bramlage, P:
Inst Pharmacol & Prevent Med, Cloppenburg, Germany
Mccalmont, G:
James Cook Univ Hosp, Dept Cardiol, Middlesbrough, England
Edwards Lifesci, Nyon, Switzerland
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