ABSTRACT
AIMS: The aim of the study was to evaluate peri-interventional complications and in-hospital complications in different team settings when performing transfemoral aortic valve replacement (TAVR) under local anaesthesia. METHODS AND RESULTS: We performed TAVR under local anaesthesia with a minimalist Heart Team consisting of two interventional cardiologists, an echocardiographer and two cardiac catheterisation laboratory nurses. In August 2015, new guidelines for TAVR were issued by the National Federal Joint Committee. In accordance with these guidelines, we began to perform TAVR using a complete Heart Team, consisting of two interventional cardiologists, an echocardiographer, a cardiac surgeon, an anaesthesiologist, a cardiovascular perfusionist, two cardiac catheterisation laboratory nurses, a surgical nurse and an anaesthetist nurse. In this study, we retrospectively analysed periprocedural and in-hospital outcomes. Two hundred and ninety-two (55.1%) patients were treated by the minimalist Heart Team, whereas 238 (44.9%) were treated by the complete Heart Team. There were no significant differences in periprocedural (1.4% vs. 1.3%, p=1.0) and in-hospital mortality (4.8% vs. 5.0%, p=0.9) as well as in conversion to open heart (0.3% vs. 0.8%, p=0.59) or immediate vascular surgery (0.3% vs. 2.1%, p=0.1) for minimalist versus complete Heart Team, respectively. CONCLUSIONS: TAVR under local anaesthesia can be safely performed by a minimalist Heart Team. We did not observe any differences in fatal periprocedural complications and mortality when compared with those of a complete Heart Team.
Subject(s)
Aortic Valve Stenosis , Transcatheter Aortic Valve Replacement , Anesthesia, Local , Aortic Valve , Cardiac Catheterization , Humans , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a standard therapy for aortic valve stenosis in patients at intermediate-to-high surgical risk. Previously, TAVI at our site was performed by a minimalist heart team (MHT), comprised of two interventional cardiologists, echocardiography staff and two cardiac catheterization laboratory nurses. After revision of German Federal Joint Committee (G-BA) guidelines in September 2015, the presence of an extended heart team (EHT; including a full cardiac surgical team) became mandatory throughout the TAVI procedure. We aimed to evaluate the impact of the EHT on clinical and economical outcomes. METHODS: Data was retrospectively extracted from the medical records of patients receiving an Edwards SAPIEN 3 valve at the University Hospital Tübingen, Germany, between 2014 and 2017 and matched with cost data from the national invoice system of hospitals (InEK). For comparison, patients were grouped according to whether they underwent TAVI with or without the EHT. RESULTS: Overall, data for 341 patients (MHT 233; EHT 118) were analysed. Baseline characteristics were largely similar between groups (mean age 81.0 years; 54.5% female), though EHT patients had a lower mean logEuroSCORE (17.5% vs. 19.8%; p = 0.011) and more prior PCI/stenting (39.0% vs. 26.9%; p = 0.022). The rate of immediate procedural death (1.7%) was comparable between groups, as was mortality at 30 days (4.2%). Overall, 1.2% of patients required conversion to surgery. The cost of the index hospitalisation (minus the prosthesis) was higher in the EHT condition (difference + 1604), largely driven by expenditure on physicians (difference + 581; p < 0.001), medical technicians (difference + 372; p < 0.001) and medical supplies (difference +244; p = 0.001). CONCLUSION: At our site, the presence of an EHT throughout the TAVI procedure appears to substantially increase hospital expenditure without significantly improving patient outcomes. We suggest that TAVI by a minimalist HT with a surgical team on call in case of emergency may be sufficient.
