A streamlined pathway for transcatheter aortic valve implantation: the BENCHMARK study

Author:

Frank Derk12ORCID,Durand Eric3ORCID,Lauck Sandra4ORCID,Muir Douglas F5ORCID,Spence Mark6,Vasa-Nicotera Mariuca7,Wood David4,Saia Francesco8ORCID,Urbano-Carrillo Cristóbal A9ORCID,Bouchayer Damien10,Iliescu Vlad Anton11ORCID,Saint Etienne Christophe12,Leclercq Florence13ORCID,Auffret Vincent14ORCID,Asmarats Lluis1516ORCID,Di Mario Carlo17ORCID,Veugeois Aurelie18,Maly Jiri19ORCID,Schober Andreas2021ORCID,Nombela-Franco Luis22ORCID,Werner Nikos23,Gómez-Hospital Joan Antoni24ORCID,Mascherbauer Julia25ORCID,Musumeci Giuseppe26ORCID,Meneveau Nicolas27ORCID,Meurice Thibaud28,Mahfoud Felix29ORCID,De Marco Federico30ORCID,Seidler Tim313233ORCID,Leuschner Florian34ORCID,Joly Patrick35,Collet Jean-Philippe36ORCID,Vogt Ferdinand37ORCID,Di Lorenzo Emilio38,Kuhn Elmar39ORCID,Disdier Vicente Peral40ORCID,Hachaturyan Violetta41ORCID,Lüske Claudia M41ORCID,Rakova Radka42ORCID,Wesselink Wilbert42ORCID,Kurucova Jana42ORCID,Bramlage Peter41ORCID,McCalmont Gemma543ORCID, ,Frank Derk,McCalmont Gemma,Bramlage Peter,Lüske Claudia M,Zielinski Marie,Greinert Daniel,Deutsch Cornelia,Hachaturyan Violetta,Durand Eric,Lauck Sandra,Muir Douglas,Spence Mark,Vasa-Nicotera Mariuca,Wood David,Saia Francesco,Kurucova Jana,Wesselink Wilbert,Rakova Radka,Thoenes Martin,Urbano-Carrillo Cristóbal A,García Carlos Lara,Chamorro Beatriz,Bouchayer Damien,Claudel Jean-Philippe,Perrier Hervé,Frebault Viktoria,Iliescu Vlad Anton,Parasca Catalina Andreea,Etienne Christophe Saint,Lassouani Katia,Leclercq Florence,Zitouni Wassim,Soltani Sonia,Auffret Vincent,Gal Rosalie Le,Asmarats Lluis,Xarrie Elena Jimenez,Di Mario Carlo,Ciardetti Niccolo,Meucci Francesco,Veugeois Aurelie,Bagdadi Imane,Maly Jiri,Kolinova Lenka,Schober Andreas,Delle-Karth Georg,Schuster Claudia,Leitgeb Marie-Christine,Nombela-Franco Luis,García Esther Bernardo,Pozzi María Aránzazu Ortega,Werner Nikos,Leick Jürgen,Lauterbach Michael,Waschbüsch Hannah,Antoni Joan,Muntané Guillem,Daxböck Julia Mascherbauer Olga,Butkovic Mirela,Popescu Simona,Musumeci Giuseppe,Perrero Martina,Meneveau Nicolas,Watbled Stephanie,Meurice Thibaud,Delomez Maxence,Mahfoud Felix,Scheller Bruno,Ewen Sebastian,Berger Ann-Kathrin,Koch Christina,Engel Alexandra,De Marco Federico,Olivares Paolo,Seidler Tim,Wolf Frieder,Müller Carolin,Hünermund Maren,Leuschner Florian,Konstandin Mathias,Linz Lisa,Ulbricht Hannah,Joly Patrick,Siame Sabrina,Collet Jean-Philippe,Amrane Nassima Ait,Vogt Ferdinand,Rosenzweig Dow,Di Lorenzo Emilio,Cefalo Barbara,Kuhn Elmar,Wolf Vera,Disdier Vicente Peral,Daunert Jaume Maristany,de la Bandera Sanchez Maria Carmen

Affiliation:

1. Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), University Clinical Centre Schleswig-Holstein (UKSH) , Arnold-Heller Strasse 3, Haus K3, Kiel 24105 , Germany

2. Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), German Centre for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Arnold-Heller Strasse 3 , Haus K3, Kiel 24105 , Germany

3. Department of Cardiology, Univ Rouen Normandie, Inserm U1096, CHU Rouen , Rouen , France

4. Centre for Cardiovascular Innovation, University of British Columbia , Vancouver, BC , Canada

5. Cardiology Department, James Cook University Hospital , Middlesbrough , UK

6. Cardiology Department, Mater Private Network , Dublin , Ireland

7. Cardiology Department, Hospital Sindelfingen-Böblingen , Sindelfingen , Germany

8. Department of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi , Bologna , Italy

9. Cardiology Department, Hospital Regional Universitario de Málaga , Malaga , Spain

10. Department of Cardiology, The Clinique de l'Infirmerie Protestante , Lyon , France

11. Department of Cardiology, University of Medicine and Pharmacy Carol Davila , Bucharest , Romania

12. Department of Cardiology, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau , Tours , France

13. Cardiology Department, Montpellier University Hospital, Montpellier University , Montpellier , France

14. Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099 , Rennes , France

15. Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau , Barcelona , Spain

16. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) , Madrid , Spain

17. Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital , Florence , Italy

18. Department of Cardiology, Institut Mutualiste Montsouris , Paris , France

19. Cardiac Center, IKEM Prague , Prague , Czech Republic

20. Department of Cardiology, Hospital Floridsdorf , Vienna , Austria

21. Karl Landsteiner Institute for Cardiovascular and Critical Care Research Vienna , Vienna , Austria

22. Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) , Madrid , Spain

23. Medical Department III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder , Trier , Germany

24. Heart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona , Barcelona , Spain

25. Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten , St. Pölten , Austria

26. Struttura Complessa of Cardiology, Ospedale Mauriziano , Torino , Italy

27. Cardiology, Besancon Regional University Hospital Center , Besancon , France

28. Cardiology, Polyclinique Du Bois , Lille , France

29. Internal Medicine III, Cardiology, Angiology and Internal Intensive Care Medicine, University Hospital of Saarland , Homburg , Germany

30. Cardiology, Centro Cardiologico Monzino , Milan , Italy

31. Department of Cardiology and Pulmonology, Georg-August-University , Göttingen , Germany

32. Department of Cardiology, University Medicine Göttingen, Heart Center , Göttingen , Germany

33. Department of Cardiology, Kerckhoff-Klinik , Bad Nauheim , Germany

34. Department of Medicine III, University of Heidelberg, German Centre for Cardiovascular Research (DZHK) , Heilderberg , Germany

35. Department of Interventional Cardiology, Hôpital Saint Joseph , Marseille , France

36. Department de Cardiologie, Hôpital de Pitié-Salpêtrière AP-HP , Paris , France

37. Department for Cardiovascular Surgery, Artemed Klinikum München , München , Germany

38. Division of Cardiology, Department of Cardiovascular Surgery, L’Ospedale S.Giuseppe Moscati di Avellino , Avellino , Italy

39. Department of Cardiothoracic Surgery, Heart Center, Faculty of Medicine, University Hospital of Cologne , Cologne , Germany

40. Cardiology Department, University Hospital Son Espases , Palma de Mallorca , Spain

41. Institute for Pharmacology and Preventive Medicine , Cloppenburg , Germany

42. Edwards Lifesciences , Prague , Czech Republic

43. Edwards Lifesciences , Nyon , Switzerland

Abstract

Abstract Background and Aims There is significant potential to streamline the clinical pathway for patients undergoing transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate the effect of implementing BENCHMARK best practices on the efficiency and safety of TAVI in 28 sites in 7 European countries. Methods This was a study of patients with severe symptomatic aortic stenosis (AS) undergoing TAVI with balloon-expandable valves before and after implementation of BENCHMARK best practices. Principal objectives were to reduce hospital length of stay (LoS) and duration of intensive care stay. Secondary objective was to document patient safety. Results Between January 2020 and March 2023, 897 patients were documented prior to and 1491 patients after the implementation of BENCHMARK practices. Patient characteristics were consistent with a known older TAVI population and only minor differences. Mean LoS was reduced from 7.7 ± 7.0 to 5.8 ± 5.6 days (median 6 vs. 4 days; P < .001). Duration of intensive care was reduced from 1.8 to 1.3 days (median 1.1 vs. 0.9 days; P < .001). Adoption of peri-procedure best practices led to increased use of local anaesthesia (96.1% vs. 84.3%; P < .001) and decreased procedure (median 47 vs. 60 min; P < .001) and intervention times (85 vs. 95 min; P < .001). Thirty-day patient safety did not appear to be compromised with no differences in all-cause mortality (0.6% in both groups combined), stroke/transient ischaemic attack (1.4%), life-threatening bleeding (1.3%), stage 2/3 acute kidney injury (0.7%), and valve-related readmission (1.2%). Conclusions Broad implementation of BENCHMARK practices contributes to improving efficiency of TAVI pathway reducing LoS and costs without compromising patient safety.

Funder

Edwards Lifesciences and performed under the sponsorship of IPPMed

Institute for Pharmacology and Preventive Medicine GmbH

Publisher

Oxford University Press (OUP)

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