Development and Early Experience of the First Joint Military Health System-Veterans Affairs Transcatheter Aortic...

Area of Science:

• Cardiology
• Cardiac Surgery
• Health Services Research

Background:

• Aortic stenosis is a common valvular heart condition in older adults, with valve replacement being the primary treatment.
• Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that has transformed aortic stenosis management.
• No medical therapies can halt the progression of aortic stenosis.

Purpose of the Study:

• To describe the development and outcomes of a unique collaborative Transcatheter Aortic Valve Replacement (TAVR) program at Naval Medical Center San Diego and the VA San Diego Healthcare System.
• To evaluate the initial patient outcomes and cost-effectiveness of this novel federal TAVR program.

Main Methods:

• The program involved multiyear development with administrative support, facility upgrades, and a multispecialty heart valve team.
• Retrospective review of 29 patients referred for TAVR evaluation over the first 9 months.
• Analysis of procedural outcomes, mortality, and cost savings compared to non-federal institutions.

Main Results:

• Twenty-two patients underwent TAVR, with an average age of 80 years.
• Patients had a predicted surgical mortality risk of 7.7%, consistent with other studies.
• Zero deaths were recorded at a mean follow-up of 5.6 months, with an approximate 17% cost saving per patient.

Conclusions:

• The collaborative TAVR program demonstrated positive initial results, aligning with national and international data.
• The program achieved significant cost containment and improved patient care.
• This model can guide other federal facilities in establishing similar programs to enhance healthcare quality and patient experience.