A streamlined pathway for transcatheter aortic valve implantation: the BENCHMARK study

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...

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Detalles Bibliográficos
Autores: 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
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p17683
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17683
http://ddd.uab.cat/record/305889
Access Level:acceso abierto
Palabra clave:Aortic stenosis
Quality of care
Prospective registry
Transcatheter aortic valve implantation
TAVI
Clinical care
Health services
Descripción
Sumario: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.

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