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Article Dans Une Revue European Heart Journal Année : 2024

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

Sandra Lauck
Douglas F Muir
Mark Spence
  • Fonction : Auteur
Mariuca Vasa-Nicotera
  • Fonction : Auteur
David Wood
Damien Bouchayer
  • Fonction : Auteur
Florence Leclercq
Lluis Asmarats
Carlo Di Mario
Andreas Schober
Nikos Werner
  • Fonction : Auteur
Joan Antoni Gomez-Hospital
Julia Mascherbauer
Giuseppe Musumeci
Nicolas Meneveau
Thibaud Meurice
  • Fonction : Auteur
Felix Mahfoud
Federico de Marco
Patrick Joly
  • Fonction : Auteur
Jean-Philippe Collet
Ferdinand Vogt
Emilio Di Lorenzo
  • Fonction : Auteur
Elmar Kuhn
Vicente Peral Disdier
Violetta Hachaturyan
Claudia M Lüske
Radka Rakova
Wilbert Wesselink
Jana Kurucova
Peter Bramlage
Gemma Mccalmont

Résumé

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.
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hal-04534032 , version 1 (05-04-2024)

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Derk Frank, Eric Durand, Sandra Lauck, Douglas F Muir, Mark Spence, et al.. A streamlined pathway for transcatheter aortic valve implantation: the BENCHMARK study. European Heart Journal, 2024, pp.ehae147. ⟨10.1093/eurheartj/ehae147⟩. ⟨hal-04534032⟩
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