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Original research
Effect of procedural refinement of transfemoral transcatheter aortic valve implantation on outcomes and costs: a single-centre retrospective study
  1. Sivasankar Sangaraju1,
  2. Ian Cox1,
  3. Malcolm Dalrymple-Hay1,
  4. Clinton Lloyd1,
  5. Venkatesan Suresh1,
  6. Tania Riches1,
  7. Samantha Melhuish1,
  8. Sanjay Asopa1,
  9. Samantha Newcombe1,
  10. Cornelia Deutsch2 and
  11. Peter Bramlage2
  1. 1 Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
  2. 2 Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
  1. Correspondence to Prof. Dr. Peter Bramlage, Institute for Pharmacology and Preventive Medicine, Cloppenburg 49661, Germany; peter.bramlage{at}


Objectives To determine the effect of introducing several procedural refinements of transfemoral transcatheter aortic valve implantation (TAVI) on clinical outcomes and costs.

Design Retrospective analysis comparing two consecutive 1-year periods, before and after the introduction of procedural refinements.

Setting Tertiary hospital aortic valve programme.

Participants Consecutive patients undergoing transfemoral TAVI treated between April 2014 and August 2015 using the initial setup (n=70; control group) or between September 2015 and August 2016 after the introduction of procedural refinements (n=89).

Interventions Introduction of conscious sedation, percutaneous access and closure, omission of transoesophageal echocardiography during the procedure, and an early discharge procedure.

Outcome measures Procedural characteristics, complications and outcomes; length of stay in intensive care unit (ICU) and hospital; hospital-related direct costs associated with TAVI.

Results There were no statistically significant differences in the incidence of complications or mortality between the two groups. The mean length of stay in the ICU was significantly shorter in the procedural-refinement group compared with the control group (5.1 vs 57.2 hours, p<0.001), as was the mean length of hospital stay (4.7 vs 6.6 days, p<0.001). The total cost per TAVI procedure was significantly lower, by £3580, in the procedural-refinement group (p<0.001). This was largely driven by lower ICU costs.

Conclusions Among patients undergoing transfemoral TAVI, procedural refinement facilitated a shorter stay in ICU and earlier discharge from hospital and was cost saving compared with the previous setup.

  • Aortic stenosis
  • conscious sedation
  • costs
  • Sapien 3
  • Sapien XT
  • transcatheter aortic valve implantation
  • transcatheter aortic valve replacement

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  • Contributors SS designed the work, initiated data collection, interpreted the data, revised the manuscript for important intellectual content and released the work for submission. Ian IC, MD-H, CL, VS, TR, SM, SA, SN did the clinical work, were responsible for the data collection, revised the manuscript for important intellectual content and released the work for submission. CD analysed the data, interpreted the data, revised the manuscript for important intellectual content and released the work for submission. PB designed the work, interpreted the data, advised on the statistical analysis, drafted the manuscript and released the work for submission.

  • Funding Edwards Lifesciences provided funding for the preparation of this manuscript.

  • Competing interests Peter Bramlage discloses having received research funding from Edwards Lifesciences. Cardiology and Cardiothoracic Departments at University Hospitals Plymouth NHS Trust received an educational grant from Edwards Lifesciences. The other authors have no conflicts of interest to disclose.

  • Patient consent for publication Not required.

  • Ethics approval Since it was a retrospective study involving anonymised data collection, no ethics committee approval was necessary.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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