Abstract
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.
References
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Acknowledgements
This study was in part funded by the DFG (German Research Foundation) Klinische Forschergruppe 274—Platelets—Molecular Mechanisms and Translational Implications and the Collaborative Research Center Transregio 240. We acknowledge the help of Helen Sims (both Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany) with the preparation of the manuscript and Lars Knapp (University Hospital Tübingen, Management and Controlling) with collection of InEK data.
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MD received travel honoraria by Medtronic; MG has received speaker’s fees from Medtronic and AstraZeneca; TG received restricted grants by Edwards and travel honoraria by Medtronic; PB received consultancy honoraria from Edwards Lifesciences for the preparation of the first draft; OB, TK, RK, HL, CS, CG have nothing to disclose.
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Droppa, M., Borst, O., Katzenberger, T. et al. Clinical and economical impact of the presence of an extended heart team throughout the balloon-expandable transcatheter aortic valve implantation procedure. Clin Res Cardiol 108, 315–323 (2019). https://doi.org/10.1007/s00392-018-1359-3
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DOI: https://doi.org/10.1007/s00392-018-1359-3