A streamlined pathway for transcatheter aortic valve implantation: the BENCHMARK study
Derk Frank, Éric Durand, Sandra Lauck, Douglas Muir, Mark Spence, Mariuca Vasa‐Nicotera, David Wood, Francesco Saia, Cristóbal A. Urbano-Carrillo, Damien Bouchayer, Vlad Anton Iliescu, Christophe Saint Etienne, Florence Leclercq, Vincent Auffret, Lluis Asmarats, Carlo Di Mario, Aurelie Veugeois, Jiří Malý, Andreas Schober, Luis Nombela-Franco, Nikos Werner, Julia Mascherbauer, Giuseppe Musumeci, Nicolas Méneveau, Thibaud Meurice, Felix Mahfoud, Federico De Marco, Tim Seidler, Florian Leuschner, Patrick Joly, Jean‐Philippe Collet, Ferdinand Vogt, Emilio Di Lorenzo, Elmar Kuhn, Vicente Peral Disdier, Violetta Hachaturyan, Claudia M. Lüske, Radka Rakova, W.A. Wesselink, Jana Kurucova, Peter Bramlage, Gemma McCalmont, for the BENCHMARK Investigator Group, Derk Frank, Gemma McCalmont, Peter Bramlage, Claudia M. Lüske, Marie Zielinski, Daniel Greinert, Cornelia Deutsch, Violetta Hachaturyan, Éric Durand, Sandra Lauck, Douglas Muir, Mark Spence, Mariuca Vasa‐Nicotera, David A. Wood, Francesco Saia, Jana Kurucova, W.A. Wesselink, Radka Rakova, Martin Thoenes, Cristóbal A. Urbano-Carrillo, Carlos Lara García, Beatriz Chamorro, Damien Bouchayer, Jean-Philippe Claudel, Hervé Perrier, Viktoria Frebault, Vlad Anton Iliescu, Catalina A. Parasca, Christophe Saint Etienne, Katia Lassouani, Florence Leclercq, Wassim Zitouni, Sonia Soltani, Vincent Auffret, Rosalie Le Gal, Lluis Asmarats, Elena Jiménez Xarrié, Carlo Di Mario, Niccolò Ciardetti, Francesco Meucci, Aurelie Veugeois, Imane Bagdadi, Jiří Malý, Lenka Kolinova, Andreas Schober, Georg Delle‐Karth, C. Schuster, Marie-Christine Leitgeb, Luis Nombela-Franco, Esther Bernardo García, María Aranzazu Ortega Pozzi, Nikos Werner, Juergen Leick, Michael Lauterbach, Hannah Waschbüsch, Joan Antoni, Guillem Muntané
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.