Dion Stub1, Sandra Lauck2, May Lee3, Min Gao3, Karin Humphries4, Albert Chan5, Anson Cheung6, Richard Cook7, Anthony Della Siega8, Jonathon Leipsic6, Jay Charania9, Danny Dvir6, Tim Latham9, Jopie Polderman10, Simon Robinson8, Daniel Wong9, Christopher R Thompson6, David Wood7, Jian Ye6, John Webb11. 1. Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; Division of Cardiology, Alfred Hospital, Western Health, Baker IDI Heart and Diabetes Institute, Melbourne Australia. 2. Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cardiac Services BC, Vancouver, British Columbia, Canada. 3. BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada. 4. University of British Columbia, Vancouver, British Columbia, Canada; BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada. 5. University of British Columbia, Vancouver, British Columbia, Canada; Divisions of Cardiology and Cardiac Surgery, Royal Columbian Hospital, Vancouver, British Columbia, Canada. 6. Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada. 7. Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Divisions of Cardiology and Cardiac Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada. 8. Division of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada. 9. Divisions of Cardiology and Cardiac Surgery, Royal Columbian Hospital, Vancouver, British Columbia, Canada. 10. Cardiac Services BC, Vancouver, British Columbia, Canada. 11. Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cardiac Services BC, Vancouver, British Columbia, Canada. Electronic address: john.webb@vch.ca.
Abstract
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.
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.
Authors: Sahil Khera; Dhaval Kolte; Tanush Gupta; Andrew Goldsweig; Poonam Velagapudi; Ankur Kalra; Gilbert H L Tang; Wilbert S Aronow; Gregg C Fonarow; Deepak L Bhatt; Herbert D Aronow; Neal S Kleiman; Michael Reardon; Paul C Gordon; Barry Sharaf; J Dawn Abbott Journal: JAMA Cardiol Date: 2017-07-01 Impact factor: 14.676
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Authors: Sandra B Lauck; Maggie Yu; Lillian Ding; Sean Hardiman; Daniel Wong; Janarthanan Sathananthan; Jian Ye; Albert Chan; Steven Hodge; Simon Robinson; David A Wood; John G Webb Journal: CJC Open Date: 2021-04-24
Authors: Katja Bohmann; Christof Burgdorf; Tobias Zeus; Michael Joner; Héctor Alvarez; Kira Lisanne Berning; Maren Schikowski; Albert Markus Kasel; Gesine van Mark; Cornelia Deutsch; Jana Kurucova; Martin Thoenes; Derk Frank; Steffen Wundram; Peter Bramlage; Barbara Miller; Verena Veulemans Journal: J Clin Med Date: 2022-02-23 Impact factor: 4.241