Regional Systems of Care to Optimize Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement
| Autor: | Anthony Della Siega, Anson Cheung, Karin H. Humphries, John G. Webb, May Lee, Jonathon Leipsic, Christopher R. Thompson, Sandra Lauck, Albert W. Chan, T. Latham, Daniel R. Wong, J. Charania, Dion Stub, J. Polderman, Simon D. Robinson, D. Dvir, Jian Ye, David A. Wood, Min Gao, Richard C. Cook |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Cardiac Catheterization Time Factors medicine.medical_treatment Valve replacement Risk Factors Interquartile range Hospital Mortality Prospective Studies Registries Myocardial infarction Referral and Consultation Stroke Aged 80 and over Heart Valve Prosthesis Implantation Delivery of Health Care Integrated Process Assessment Health Care Quality Improvement 3. Good health Treatment Outcome Aortic Valve Heart Valve Prosthesis Cohort transcatheter aortic valve replacement Female Health Services Research Cardiology and Cardiovascular Medicine medicine.medical_specialty Transcatheter aortic Risk Assessment Regional Health Planning medicine Humans Aged Quality Indicators Health Care Patient Care Team British Columbia business.industry Patient Selection aortic stenosis Aortic Valve Stenosis Length of Stay medicine.disease Surgery Stenosis Models Organizational Emergency medicine Observational study business Program Evaluation |
| Zdroj: | JACC: Cardiovascular Interventions. 8(15):1944-1951 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2015.09.017 |
| Popis: | Objectives This study sought to describe the development of a multicenter, transcatheter aortic valve replacement program and regional systems of care intended to optimize coordinated, efficient, and appropriate delivery of this new therapy. Background Transcatheter aortic valve replacement (TAVR) has become an accepted treatment option for patients with severe aortic stenosis who are at high surgical risk. Regional systems of care have led to improvements in outcomes for patients undergoing intervention for myocardial infarction, cardiac arrest, and stroke. We implemented a regional system of care for patients undergoing TAVR in British Columbia, Canada. Methods We describe a prospective observational cohort of 583 patients who underwent TAVR in British Columbia between 2012 and 2014. Regionalization of TAVR care in British Columbia refers to a centrally coordinated, funded, and evaluated program led by a medical director and a multidisciplinary advisory group that oversees planning, access to care, and quality of outcomes at the 4 provincial sites. Risk-stratified case selection for transfemoral TAVR is performed by heart teams at each site on the basis of consensus provincial indications. Referrals for lower volume and more complicated TAVR, including nontransfemoral access and valve-in-valve procedures, are concentrated at a single site. In-hospital and 30-day outcomes are reported. Results The median age was 83 years (interquartile range [IQR]: 78 to 87 years) and median STS score was 6% (IQR: 4% to 8%). Transfemoral access was performed in 499 (85.6%) cases and nontransfemoral in 84 (14.4%). Transcatheter valve-in-valve procedures in for failed bioprosthetic valves were performed in 43 patients (7.4%). A balloon-expandable valve was inserted in 386 (66.2%) and a self-expanding valve in 189 (32.4%). All-cause 30-day mortality was 3.5%. All-cause in-hospital mortality and disabling stroke occurred in 3.1% and 1.9%, respectively. Median length of stay was 3 days (IQR: 3 to 6 days), with 92.8% of patients discharged directly home. Conclusions This experience demonstrates the potential benefits of a regional system of care for TAVR. Excellent outcomes were demonstrated: most patients had short in-hospital stays and were discharged directly home. |
| Databáze: | OpenAIRE |
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