scholarly journals Clinical process optimization of transfemoral transcatheter aortic valve implantation

2020 ◽  
Author(s):  
Julia Lortz ◽  
Tobias Peter Lortz ◽  
Laura Johannsen ◽  
Christos Rammos ◽  
Martin Steinmetz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Transcatheter Aortic Valve Implantation ◽  
Time Range ◽  
Major Goal ◽  
Clinical Process ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Prolonged Hospital ◽  
Valve Implantation

Background: The avoidance of prolonged hospital stay is a major goal in the management of transcatheter aortic valve implantation (TAVI) – medically and economically. Materials & methods: We compared the time range of the preprocedural length of stay in 2014/2015 with 2016/2017, after the implementation of the TAVI coordinator in 2016. This included restructured pathways for screening and pre-interventional diagnosis, performed examinations during the inpatient stay and major outcome variables. Results: After 2016, we observed a significant reduction in preprocedural length of stay (admission to procedure) compared with 2014/2015 (11.3 ± 7.9 vs 7.5 ± 5.6 days, p = 0.001). There was no difference in other major outcome variables. Conclusion: The introduction of the TAVI coordinator caused a shortening of preprocedural length of stay.

scholarly journals Predictors of length of stay and duration of tracheal intubation after transcatheter aortic valve implantation

2017 ◽  
Vol 9 (4) ◽  
pp. 1012-1022
Author(s):  
Vasileios Patris ◽  
Konstantinos Giakoumidakis ◽  
Mihalis Argiriou ◽  
Katerina K. Naka ◽  
Efstratios Apostolakis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Tracheal Intubation ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals A Novel Method to Predict Mortality and Length of Stay after Transfemoral Transcatheter Aortic Valve Implantation

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1332
Author(s):  
Maria Zisiopoulou ◽  
Alexander Berkowitsch ◽  
Philipp Seppelt ◽  
Andreas M. Zeiher ◽  
Mariuca Vasa-Nicotera
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Transcatheter Aortic Valve Implantation ◽  
Hospital Length Of Stay ◽  
Transcatheter Aortic Valve ◽  
Patient Reported ◽  
Novel Method ◽  
Auc Value ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background and Objectives: We tested if a novel combination of predictors could improve the accuracy of outcome prediction after transfemoral transcatheter aortic valve implantation (TAVI). Materials and Methods: This prospective study recruited 169 participants (49% female; median age 81 years). The primary endpoint was midterm mortality; secondary endpoints were acute Valve Academic Research Consortium (VARC)-3 complication rate and post-TAVI in-hospital length of stay (LoS). EuroSCORE II (ESII), comorbidities (e.g., coronary artery disease), eGFR (estimated glomerular filtration rate; based on cystatin C), hemoglobin, creatinine, N-Terminal pro-Brain Natriuretic Peptide (NTproBNP) levels and patient-reported outcome measures (PROMs, namely EuroQol-5-Dimension-5-Levels, EQ5D5L; Kansas City Cardiomyopathy Questionnaire, KCCQ; clinical frailty scale, CFS) at baseline were tested as predictors. Regression (uni- and multi-variate Cox; linear; binary logistic) and receiver operating characteristic (ROC)-curve analysis were applied. Results: Within a median follow-up of 439 (318–585) days, 12 participants died (7.1%). Independent predictors of mortality using multivariate Cox regression were baseline eGFR (p = 0.001) and KCCQ (p = 0.037). Based on these predictors, a Linear Prediction Score (LPS1) was calculated. The LPS1-area under the curve (AUC)-value (0.761) was significantly higher than the ESII-AUC value (0.597; p = 0.035). Independent predictors for LoS > 6 days (the median LoS) were eGFR (p = 0.028), NTproBNP (p = 0.034), and EQ5D5L values (p = 0.002); a respective calculated LPS2 provided an AUC value of 0.677 (p < 0.001). Eighty participants (47.3%) experienced complications. Male sex predicted complications only in the univariate analysis. Conclusions: The combination of KCCQ and eGFR can better predict midterm mortality than ES II alone. Combining eGFR, NTproBNP, and EQ5D5L can reliably predict LoS after TAVI. This novel method improves personalized TAVI risk stratification and hence may help reduce post-TAVI risk.

scholarly journals Cognitive dysfunction among patients referred for transcatheter aortic valve implantation: results of the Montreal Cognitive Assessment and clinical impact at 6 months

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Monnin ◽  
M Besutti ◽  
F Ecarnot ◽  
B Guillon ◽  
M Chatot ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Cognitive Dysfunction ◽  
Transcatheter Aortic Valve Implantation ◽  
Clinical Status ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Procedural Success ◽  
Valve Implantation ◽  
Moca Score

Abstract Background Detection of Cognitive Dysfunction (CD) is not routinely performed among patients undergoing Transcatheter Aortic Valve Implantation (TAVI). We sought to determine whether CD has an impact on the clinical course of these patients, during hospitalization at the time of TAVI and up to 6 months afterwards. Methods The MoCA was performed before TAVI by an experienced operator in an unselected population of patients referred for TAVI. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18–25, moderate if 10–17 and severe if &lt;10. Multivariate Cox logistic regression analysis was used to determine the impact of CD on procedural success of TAVI, length of stay, 6 month survival, re-admission, and change in clinical status (changes in NYHA class and/or functional status). Results MoCA was performed in 83 consecutive patients. TAVI was performed using femoral access and local anesthesia in all patients. There were no procedural deaths, and 2 deaths at 6 months. The median age was 85 years, and median Euroscore I was 11.62. The median MOCA score was 22, CD was excluded in 17 (20%), mild in 50 (60%), moderate in 15 (18%) and severe in one patient. No difference was observed in rate of procedural success, 6 month mortality, re-admission, degree of dyspnea by NYHA between the different cognitive groups. Length of stay after the TAVI procedure was lower in patients without CD, compared to those with CD at any level: 3±1 days versus 4.3±1 days, p=0.045, and p=0.02 by multivariate analysis (figure). Conclusion Among patients referred for TAVI, mild or moderate CD was observed in 80% of patients. Patients without CD had a shorter length of stay at the time of TAVI, but CD was not associated with worse prognosis or clinical status at 6 months. FUNDunding Acknowledgement Type of funding sources: None.

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