Regional System of Care May Improve Outcomes for TAVR

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Regional System of Care May Improve Outcomes for TAVR
Regional System of Care May Improve Outcomes for TAVR

WEDNESDAY, Dec. 30, 2015 (HealthDay News) -- A regional system of care seems beneficial for patients undergoing transcatheter aortic valve replacement (TAVR), according to a study published in the Dec. 28 issue of JACC: Cardiovascular Interventions.

Dion Stub, M.B.B.S., Ph.D., from St. Paul's Hospital in Vancouver, Canada, and colleagues implemented a regional system of care for patients undergoing TAVR in British Columbia, Canada, in a prospective observational cohort study involving 583 patients. Regionalization of care involved a centrally coordinated, funded, and evaluated program, which was led by a medical director and a multidisciplinary advisory team that oversaw planning, access to care, and quality of outcomes. On the basis of consensus provincial indications, heart teams performed risk-stratified case selection for transfemoral TAVR. Referrals for lower volume and more complicated procedures were concentrated at a single site.

The researchers found that transfemoral access and non-transfemoral access was performed in 85.6 and 14.4 percent of cases, respectively. In 7.4 percent of patients, transcatheter valve-in-valve procedures were performed for failed bioprosthetic valves. Overall, 66.2 and 32.4 percent of patients had a balloon-expandable and self-expanding valve inserted, respectively. The all-cause 30-day mortality was 3.5 percent; 3.1 and 1.9 percent of patients experienced all-cause in-hospital mortality and disabling stroke, respectively. The median length of stay was three days; most patients (92.8 percent) were discharged home.

"This experience demonstrates the potential benefits of a regional system of care for TAVR," the authors write.

Several authors disclosed financial ties to the medical device industry.

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