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Streamlined periprocedural management during transfemoral Transcatheter Aortic Valve Implantation: a retrospective single center cohort study

https://doi.org/10.1007/s00392-024-02406-5

Ina von der Heide (Hamburg)1, C. Kellner (Hamburg)2, S. Ludwig (Hamburg)2, T. J. Demal (Hamburg)3, L. Waldschmidt (Hamburg)1, D. Grundmann (Hamburg)2, L. Voigtländer-Buschmann (Hamburg)1, O. Bhadra (Hamburg)3, L. E. M. Hannen (Hamburg)2, F. Plaßmeier (Hamburg)3, H. Sarwari (Hamburg)4, H. Reichenspurner (Hamburg)3, S. Blankenberg (Hamburg)2, J. Schirmer (Hamburg)3, J. Auinger (Hamburg)5, R. Schnabel (Hamburg)1, L. Schulte-Uentrop (Hamburg)5, L. Conradi (Hamburg)3, N. Schofer (Hamburg)1, T. Kessler (Hamburg)5, A. Schäfer (Hamburg)3, M. Seiffert (Hamburg)2

1Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Herz- und Gefäßchirurgie Hamburg, Deutschland; 4Universitäres Herz- und Gefäßzentrum Hamburg Hamburg, Deutschland; 5Universitätsklinikum Hamburg Eppendorf Klinik und Poliklinik für Anästhesiologie Hamburg, Deutschland

 

Background: Transcatheter aortic valve implantation (TAVI) has matured to the treatment of choice for most patients with severe aortic stenosis. Procedural and technical refinements have facilitated less invasive procedures under local anesthesia with faster patient recovery. However, periprocedural management and monitoring varies widely among centers. Aim of this study was to evaluate the impact of a streamlined periprocedural management on resource utilization and outcomes of patients with severe aortic stenosis undergoing TAVI.

Methods: All consecutive patients treated with TAVI at the University Heart and Vascular Center Hamburg from 06/2021 to 06/2023 were included. Periprocedural management was adapted and streamlined in 06/2022, which included the omission of invasive blood pressure monitoring and central venous catheters. Group 1 (standard management: n=479) was compared to group 2 (streamlined management: n=452) regarding (1) resource utilization (anesthesia preparatory time before TAVI) and (2) procedural outcomes (according to VARC-3 endpoints).  

Results: The analysis included 931 patients (age 81.7 years [IQR 77.3-85.0], 57.9% male, STS-PROM 2.8% [1.9-4.6]) and was well-balanced regarding baseline and procedural characteristics. Anesthesia preparatory time was significantly longer in group 1 vs. group 2 (40.0 [30.0-50.8] vs. 27.0 [20.0-35.0], p=<0.001). VARC-3 technical success (96.4 vs. 97.4%, p=0.51) and device success (91.9 vs. 90.7%, p=0.58) were similar and no significant differences were observed in 30-day outcomes: major access site complications (3.0% vs. 1.6%, p=0.21), any bleeding (10.8% vs. 12.3%, p=0.56), stroke (4.6% vs. 3.6%, p=0.56), acute kidney injury (8.9% vs. 8.1%, p=0.75), and new pacemaker implantation (13.9% vs. 13.4%, p=0.93).

Conclusions: Based on this retrospective single center cohort study, a streamlined periprocedural management was associated with lower resource utilization and without a negative impact on outcomes after TAVI. Hence, further measures to streamline TAVI procedures may improve efficiency without compromising patient safety.

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