Improving Transcatheter Aortic Valve Implantation Efficiency and Outcomes in the Canadian Healthcare Environment

With increased demand for transcatheter aortic valve implantation (TAVI), comprehensive strategies are required to improve procedural efficiency and increase case loads at Canadian TAVI programs.

Time-efficiency measures were implemented at the preprocedure, anesthesia, procedural, and postprocedural stages at our centre between 2019 to 2024, using a 1-day-per-week strategy in a hybrid operating room. We analyzed trends in case volumes and procedural times during the study period. Patients were stratified based on whether their procedure was performed on days with a high (HCV) vs a low case volume (LCV), and differences in early clinical outcomes were analyzed. Effects of specific efficiency measures on procedural times were also analyzed.

A total of 1019 patients were analyzed. We noted significant increases in TAVI volumes (+0.51 cases per year, P < 0.0001) and a decrease in total operating room time (-10.2 minutes per year, P < 0.0001) during the study period. The time savings were driven most strongly by decreases in anesthesia and procedure times. No significant differences occurred between the HCV vs LCV groups in terms of in-hospital mortality (0.7% vs 1.8%, P = 0.20), stroke and/or transient ischemic attack (2.4% vs 2.3%, P = 0.25), new pacemaker (9.0% vs 10.1%, P = 0.64), moderate-severe paravalvular leak (2.9% vs 5.2%, P = 0.25), but increased bleeding occurred in the LCV group (3.0% vs 6.4%, P = 0.028). Multivariable linear regression showed that use of conscious sedation, left ventricular pacing, and hybrid closure strategies significantly reduced total TAVI times.

Our comprehensive, innovative time-efficiency strategies have improved TAVI efficiency significantly while preserving good outcomes and not requiring significant additional resources.