An Optimized Assessment Pathway for Remote Patients: The Vancouver Facilitated Transcatheter Aortic Valve Implantation Program.

Autor:	Husain A; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Jelisejevas J; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Chatfield A; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Akodad M; Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France., Lauck SB; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Achtem L; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Tang E; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Zaky F; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Blanke P; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Leipsic J; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Sellers SL; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.; Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada., Ye J; Division of Cardiac Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Cheung A; Division of Cardiac Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Moss R; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Wood D; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.; Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France., Boone R; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Meier D; Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada.; Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Sathananthan J; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.; Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada., Webb JG; Centre for Cardiovascular Innovation, St Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.; Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada.
Jazyk:	angličtina
Zdroj:	CJC open [CJC Open] 2024 Jul 06; Vol. 6 (10), pp. 1220-1226. Date of Electronic Publication: 2024 Jul 06 (Print Publication: 2024).
DOI:	10.1016/j.cjco.2024.07.001
Abstrakt:	Background: Novel pathways are needed to accommodate the increasing demand for transcatheter aortic valve implantation (TAVI) and ensure equitable access. A single Vancouver Facilitated TAVI program (VFTP) based at St. Paul's and Vancouver General Hospitals was established to streamline the assessment of remote patients with severe aortic stenosis using virtual technologies. Methods: Remote patients with severe aortic stenosis who expressed difficulties traveling to complete their pre-TAVI workup were included and received prospective follow-up. Clinical and echocardiographic parameters were reported per the Valve Academic Research Consortium 3. Results: Between December 2020 and March 2023, a total of 56 remote patients were included in the VFTP. The mean patient age was 79.7 ± 9.1 years. A total of 55 patients (98%) passed the screening for candidacy; 45 patients (80%) were found suitable for transfemoral TAVI, 5 patients (9%) were directed toward surgical aortic valve replacement; 3 (5%) underwent alternative-access TAVI; and 2 patients (4%) were assigned to a watchful waiting strategy. No inpatient mortality, stroke, or major bleeding occurred in the transfemoral TAVI group, and the median hospital stay was 1 day (interquartile range, 1-2 days; range, 1-24 days). Two patients had an access-closure failure requiring surgical intervention; 1 patient had tamponade; and 4 patients had complete heart block requiring permanent pacemaker implantation. No hospital readmission had occurred at 30 days. Conclusions: A simplified assessment pathway to assess TAVI candidacy using virtual technologies is safe and feasible. The VFTP potentially can increase access to TAVI and reduce inequity in TAVI care. (© 2024 The Authors.)
Databáze:	MEDLINE
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