Resource utilization for transfemoral transcatheter aortic valve replacement: An international comparison

Amar Krishnaswamy; Azeem Latib; Ali Malik; Letizia Bertoldi; Kanhaiya L. Poddar; Alaide Chieffo; Matteo Montorfano; Lars G. Svensson; Ottavio Alfieri; Antonio Colombo; E. Murat Tuzcu; Samir R. Kapadia

doi:10.1002/ccd.26056

Resource utilization for transfemoral transcatheter aortic valve replacement: An international comparison

Amar Krishnaswamy, Azeem Latib, Ali Malik, Letizia Bertoldi, Kanhaiya L. Poddar, Alaide Chieffo, Matteo Montorfano, Lars G. Svensson, Ottavio Alfieri, Antonio Colombo, E. Murat Tuzcu, Samir R. Kapadia

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2 Scopus citations

Abstract

Background Transfemoral transcatheter aortic valve replacement (TF-TAVR) has enjoyed a rapid diffusion in the US and Europe, but the procedure is resource intensive. Objectives We sought to identify differences in resource utilization between a US and European center to ascertain opportunities for improvement in the performance of TF-TAVR. Methods All patients undergoing TF-TAVR using the Edwards SAPIEN valve series at the San Raffaele Hospital (Milan, Italy) and the Cleveland Clinic Foundation (Cleveland, OH) between January 2011 and December 2012 were included. Resource utilization was defined as preprocedural imaging, intraprocedural imaging, and personnel present during the procedure. Results A total of 158 patients from Cleveland and 113 from Milan were analyzed. Median logistic EuroScore (22.1 vs. 15.5, P = 0.013) and STS-PROM (8.9 vs. 5.0%, P < 0.001) were higher in Cleveland. Thirty-day outcomes were similar. Majority of procedures in Milan were conducted without a cardiac surgeon (79%) or an imaging specialist (99%) present during the case. There was greater reliance on endotracheal intubation (94.3 vs. 3.5%), general anesthesia (GA: 94.3 vs. 4.4%), and intraprocedural TEE (93 vs. 12.4%) in Cleveland, but shorter length of stay (mean: 6.42 vs. 11.16 days). Conclusions We characterized resources used for patients undergoing TF-TAVR in Cleveland and Milan. Important differences included less reliance on GA and TEE and streamlining of procedural personnel in Milan, and reduced length-of-stay in Cleveland. Evolution of TF-TAVR to involve fewer operators must be balanced with the need for ready access to a comprehensive group of specialists in case of emergencies.

Original language	English (US)
Pages (from-to)	145-151
Number of pages	7
Journal	Catheterization and Cardiovascular Interventions
Volume	87
Issue number	1
DOIs	https://doi.org/10.1002/ccd.26056
State	Published - Jan 1 2016
Externally published	Yes

Keywords

AVD aortic valve disease
AVDP aortic valve disease percutaneous intervention
ICT imaging
electron beam CT/multidetector CT

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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10.1002/ccd.26056

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Krishnaswamy, A., Latib, A., Malik, A., Bertoldi, L., Poddar, K. L., Chieffo, A., Montorfano, M., Svensson, L. G., Alfieri, O., Colombo, A., Tuzcu, E. M., & Kapadia, S. R. (2016). Resource utilization for transfemoral transcatheter aortic valve replacement: An international comparison. Catheterization and Cardiovascular Interventions, 87(1), 145-151. https://doi.org/10.1002/ccd.26056

Krishnaswamy, A, Latib, A, Malik, A, Bertoldi, L, Poddar, KL, Chieffo, A, Montorfano, M, Svensson, LG, Alfieri, O, Colombo, A, Tuzcu, EM & Kapadia, SR 2016, 'Resource utilization for transfemoral transcatheter aortic valve replacement: An international comparison', Catheterization and Cardiovascular Interventions, vol. 87, no. 1, pp. 145-151. https://doi.org/10.1002/ccd.26056

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abstract = "Background Transfemoral transcatheter aortic valve replacement (TF-TAVR) has enjoyed a rapid diffusion in the US and Europe, but the procedure is resource intensive. Objectives We sought to identify differences in resource utilization between a US and European center to ascertain opportunities for improvement in the performance of TF-TAVR. Methods All patients undergoing TF-TAVR using the Edwards SAPIEN valve series at the San Raffaele Hospital (Milan, Italy) and the Cleveland Clinic Foundation (Cleveland, OH) between January 2011 and December 2012 were included. Resource utilization was defined as preprocedural imaging, intraprocedural imaging, and personnel present during the procedure. Results A total of 158 patients from Cleveland and 113 from Milan were analyzed. Median logistic EuroScore (22.1 vs. 15.5, P = 0.013) and STS-PROM (8.9 vs. 5.0%, P < 0.001) were higher in Cleveland. Thirty-day outcomes were similar. Majority of procedures in Milan were conducted without a cardiac surgeon (79%) or an imaging specialist (99%) present during the case. There was greater reliance on endotracheal intubation (94.3 vs. 3.5%), general anesthesia (GA: 94.3 vs. 4.4%), and intraprocedural TEE (93 vs. 12.4%) in Cleveland, but shorter length of stay (mean: 6.42 vs. 11.16 days). Conclusions We characterized resources used for patients undergoing TF-TAVR in Cleveland and Milan. Important differences included less reliance on GA and TEE and streamlining of procedural personnel in Milan, and reduced length-of-stay in Cleveland. Evolution of TF-TAVR to involve fewer operators must be balanced with the need for ready access to a comprehensive group of specialists in case of emergencies.",

keywords = "AVD aortic valve disease, AVDP aortic valve disease percutaneous intervention, ICT imaging, electron beam CT/multidetector CT",

author = "Amar Krishnaswamy and Azeem Latib and Ali Malik and Letizia Bertoldi and Poddar, {Kanhaiya L.} and Alaide Chieffo and Matteo Montorfano and Svensson, {Lars G.} and Ottavio Alfieri and Antonio Colombo and Tuzcu, {E. Murat} and Kapadia, {Samir R.}",

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T1 - Resource utilization for transfemoral transcatheter aortic valve replacement

T2 - An international comparison

AU - Krishnaswamy, Amar

AU - Latib, Azeem

AU - Malik, Ali

AU - Bertoldi, Letizia

AU - Poddar, Kanhaiya L.

AU - Chieffo, Alaide

AU - Montorfano, Matteo

AU - Svensson, Lars G.

AU - Alfieri, Ottavio

AU - Colombo, Antonio

AU - Tuzcu, E. Murat

AU - Kapadia, Samir R.

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N2 - Background Transfemoral transcatheter aortic valve replacement (TF-TAVR) has enjoyed a rapid diffusion in the US and Europe, but the procedure is resource intensive. Objectives We sought to identify differences in resource utilization between a US and European center to ascertain opportunities for improvement in the performance of TF-TAVR. Methods All patients undergoing TF-TAVR using the Edwards SAPIEN valve series at the San Raffaele Hospital (Milan, Italy) and the Cleveland Clinic Foundation (Cleveland, OH) between January 2011 and December 2012 were included. Resource utilization was defined as preprocedural imaging, intraprocedural imaging, and personnel present during the procedure. Results A total of 158 patients from Cleveland and 113 from Milan were analyzed. Median logistic EuroScore (22.1 vs. 15.5, P = 0.013) and STS-PROM (8.9 vs. 5.0%, P < 0.001) were higher in Cleveland. Thirty-day outcomes were similar. Majority of procedures in Milan were conducted without a cardiac surgeon (79%) or an imaging specialist (99%) present during the case. There was greater reliance on endotracheal intubation (94.3 vs. 3.5%), general anesthesia (GA: 94.3 vs. 4.4%), and intraprocedural TEE (93 vs. 12.4%) in Cleveland, but shorter length of stay (mean: 6.42 vs. 11.16 days). Conclusions We characterized resources used for patients undergoing TF-TAVR in Cleveland and Milan. Important differences included less reliance on GA and TEE and streamlining of procedural personnel in Milan, and reduced length-of-stay in Cleveland. Evolution of TF-TAVR to involve fewer operators must be balanced with the need for ready access to a comprehensive group of specialists in case of emergencies.

AB - Background Transfemoral transcatheter aortic valve replacement (TF-TAVR) has enjoyed a rapid diffusion in the US and Europe, but the procedure is resource intensive. Objectives We sought to identify differences in resource utilization between a US and European center to ascertain opportunities for improvement in the performance of TF-TAVR. Methods All patients undergoing TF-TAVR using the Edwards SAPIEN valve series at the San Raffaele Hospital (Milan, Italy) and the Cleveland Clinic Foundation (Cleveland, OH) between January 2011 and December 2012 were included. Resource utilization was defined as preprocedural imaging, intraprocedural imaging, and personnel present during the procedure. Results A total of 158 patients from Cleveland and 113 from Milan were analyzed. Median logistic EuroScore (22.1 vs. 15.5, P = 0.013) and STS-PROM (8.9 vs. 5.0%, P < 0.001) were higher in Cleveland. Thirty-day outcomes were similar. Majority of procedures in Milan were conducted without a cardiac surgeon (79%) or an imaging specialist (99%) present during the case. There was greater reliance on endotracheal intubation (94.3 vs. 3.5%), general anesthesia (GA: 94.3 vs. 4.4%), and intraprocedural TEE (93 vs. 12.4%) in Cleveland, but shorter length of stay (mean: 6.42 vs. 11.16 days). Conclusions We characterized resources used for patients undergoing TF-TAVR in Cleveland and Milan. Important differences included less reliance on GA and TEE and streamlining of procedural personnel in Milan, and reduced length-of-stay in Cleveland. Evolution of TF-TAVR to involve fewer operators must be balanced with the need for ready access to a comprehensive group of specialists in case of emergencies.

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KW - AVDP aortic valve disease percutaneous intervention

KW - ICT imaging

KW - electron beam CT/multidetector CT

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Resource utilization for transfemoral transcatheter aortic valve replacement: An international comparison

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