Author + information
- Received July 2, 2015
- Revision received September 9, 2015
- Accepted September 10, 2015
- Published online December 28, 2015.
- Dion Stub, MBBS, PhD∗,†,
- Sandra Lauck, PhD∗,‡,§,
- May Lee, MSc‖,
- Min Gao, MD, PhD‖,
- Karin Humphries, DSc‡,‖,
- Albert Chan, MD‡,¶,
- Anson Cheung, MD∗,‡,
- Richard Cook, MD∗,‡,#,
- Anthony Della Siega, MD∗∗,
- Jonathon Leipsic, MD∗,‡,
- Jay Charania, MD¶,
- Danny Dvir, MD∗,‡,
- Tim Latham, MD¶,
- Jopie Polderman, BSN§,
- Simon Robinson, MBChB, MD∗∗,
- Daniel Wong, MD¶,
- Christopher R. Thompson, MD∗,‡,
- David Wood, MD∗,‡,#,
- Jian Ye, MD∗,‡ and
- John Webb, MD∗,‡,§∗ ()
- ∗Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- †Division of Cardiology, Alfred Hospital, Western Health, Baker IDI Heart and Diabetes Institute, Melbourne Australia
- ‡University of British Columbia, Vancouver, British Columbia, Canada
- §Cardiac Services BC, Vancouver, British Columbia, Canada
- ‖BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
- ¶Divisions of Cardiology and Cardiac Surgery, Royal Columbian Hospital, Vancouver, British Columbia, Canada
- #Divisions of Cardiology and Cardiac Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
- ∗∗Division of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
- ↵∗Reprint requests and correspondence:
Dr. John Webb, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, BC Canada V6Z 1Y6.
Objectives This study sought to describe the development of a multicenter, transcatheter aortic valve replacement program and regional systems of care intended to optimize coordinated, efficient, and appropriate delivery of this new therapy.
Background Transcatheter aortic valve replacement (TAVR) has become an accepted treatment option for patients with severe aortic stenosis who are at high surgical risk. Regional systems of care have led to improvements in outcomes for patients undergoing intervention for myocardial infarction, cardiac arrest, and stroke. We implemented a regional system of care for patients undergoing TAVR in British Columbia, Canada.
Methods We describe a prospective observational cohort of 583 patients who underwent TAVR in British Columbia between 2012 and 2014. Regionalization of TAVR care in British Columbia refers to a centrally coordinated, funded, and evaluated program led by a medical director and a multidisciplinary advisory group that oversees planning, access to care, and quality of outcomes at the 4 provincial sites. Risk-stratified case selection for transfemoral TAVR is performed by heart teams at each site on the basis of consensus provincial indications. Referrals for lower volume and more complicated TAVR, including nontransfemoral access and valve-in-valve procedures, are concentrated at a single site. In-hospital and 30-day outcomes are reported.
Results The median age was 83 years (interquartile range [IQR]: 78 to 87 years) and median STS score was 6% (IQR: 4% to 8%). Transfemoral access was performed in 499 (85.6%) cases and nontransfemoral in 84 (14.4%). Transcatheter valve-in-valve procedures in for failed bioprosthetic valves were performed in 43 patients (7.4%). A balloon-expandable valve was inserted in 386 (66.2%) and a self-expanding valve in 189 (32.4%). All-cause 30-day mortality was 3.5%. All-cause in-hospital mortality and disabling stroke occurred in 3.1% and 1.9%, respectively. Median length of stay was 3 days (IQR: 3 to 6 days), with 92.8% of patients discharged directly home.
Conclusions This experience demonstrates the potential benefits of a regional system of care for TAVR. Excellent outcomes were demonstrated: most patients had short in-hospital stays and were discharged directly home.
Dr. Stub is supported by a joint NHMRC and NHF early career fellowship (#1090302/100516); and has served as a consultant to Edwards Lifesciences. Drs. Lauck and Ye have served as consultants to Edwards Lifesciences. Drs. Leipsic, Dvir, and Webb have received grants and personal fees from Edwards Lifesciences. Dr. Leipsic provides CT core laboratory services for Edwards Lifesciences, Neovasc, and Tendyne; and has served as a consultant for Edwards Lifesciences, Neovasc, Heartflow, and Circle CVI. Dr. Thompson has received minor travel support from Edwards Lifesciences. Dr. Wood has received grant support from and served as a consultant for Edwards Lifesciences. Dr. Webb has served as a consultant for Edwards Lifesciences and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 2, 2015.
- Revision received September 9, 2015.
- Accepted September 10, 2015.
- 2015 American College of Cardiology Foundation