The first published data for TAVI in private hospitals show that appropriate patient selection, high procedural volume and CT-guidance are keys to success in a TAVI program.
The review covered the first 300 patients with severe, symptomatic aortic stenosis treated at the St Andrew’s War Memorial Hospital Brisbane, who underwent TAVI from 2015 through to August 2018.
Patients had a median age of 85 years and median STS predicted risk of mortality score of 4.0%.
Prior percutaneous balloon aortic valvuloplasty (PBAV) was performed in 69.7% of cases overall with the rate decreasing over time from 90% in the first 50 cases to 36% in the last 50 cases.
Patients were typically in ICU for 24 hours after their TAVI and discharged from hospital after three days.
There was one intra-procedural death, three deaths at the 30-day follow-up (1%) and 11 at 12-months (4.2%).
Amongst other reported outcomes, there was a small (3%) rate of major vascular complications, no life threatening bleeds and no aortic valve reinterventions.
“Post-procedural echocardiography showed no paravalvular leak in 27%, trace in 53% and mild in 20%. One patient had grade 2/4 paravalvular leak. There were no grade ≥3/4 paravalvular leaks.”
The authors, including cardiologists and cardiothoracic surgeons from St Andrews, said they were the first to report TAVI outcomes from an Australian private hospital.
“TAVI is still in its’ infancy in the Australian private sector, previously being limited to tertiary, publicly funded hospitals. When compared to registries from well-established centres in the United States and Germany, we show excellent outcomes in Australian patients.”
They said TAVIs should probably be delivered in a few centres of excellence to ensure the best possible outcomes.
“This will allow hospitals to maintain high volume to keep cardiologists, nursing, intensive care, anaesthetic and radiology staff highly skilled in TAVI patient management.”
Appropriate patient selection was also critical and should involve a multidisciplinary heart team meeting.
And, procedural CT guidance was pivotal, they said.
“We believe it is a strength for the procedural, structural cardiologist/surgeon themselves to be skilled in CT interpretation. This allows the operator to be aware of all challenges from periphery to aortic annulus from a procedural point of view.”
“In conclusion, it is evident that a dedicated TAVI program with a skilled team doing high volume in the Australian private hospital setting can deliver excellent and efficient results.”