Transcatheter Aortic Valve Replacement (TAVR): A Comprehensive Descriptive Analysis

Faria Nisar; Nicolas Mas D Alessandro; Alexander Estright; Samantha Pope; Daniel Schiller; Luis Tollinche; Maninder Singh

doi:10.61797/ijetit.v6i2.545

Faria Nisar Assistant Professor, Department of Anaesthesiology & Pain Management, Metro Health System, 2500 Metro Health Drive, Cleveland, OH 44109, United States https://orcid.org/0009-0004-8563-1967
Nicolas Mas D Alessandro Resident Doctor, Department of Anaesthesiology & Pain Management, Metro Health System, 2500 Metro Health Drive, Cleveland, OH 44109, United States https://orcid.org/0000-0002-1182-6399
Alexander Estright Student, Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH 44106, United States
Samantha Pope Research Regulatory Specialist, Department of Anaesthesiology & Pain Management, Metro Health System, 2500 Metro Health Drive, Cleveland, OH 44109, United States https://orcid.org/0009-0000-5913-6269
Daniel Schiller Professor, Department of Anaesthesiology & Pain Management, Metro Health System, 2500 Metro Health Drive, Cleveland, OH 44109, United States
Luis Tollinche Professor, Case Comprehensive Cancer Center, Case Western Reserve University, 10900 Euclid Ave Ste 1422, Cleveland, OH 44106, United States https://orcid.org/0000-0002-1283-7102
Maninder Singh Associate Professor, Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH 44106, United States https://orcid.org/0009-0007-7710-4325

DOI: https://doi.org/10.61797/ijetit.v6i2.545

Keywords: TAVR, SAVR, Aortic stenosis, Cardiovascular complications, Lower volume healthcare institution, Healthcare system analysis

Abstract

Objectives: TAVR is a minimally invasive alternative to SAVR, offering a key treatment for high-risk patients with severe aortic stenosis, including those with advanced age or comorbidities. Its popularity has led to its use in lower volume institutions, where outcomes are comparable to higher volume centers. This study analyzes procedural volume and outcomes at our institution, compares them with the PARTNER III trial and evaluates complications and patient selection criteria.

Design: This was a retrospective descriptive study.

Setting: This study was performed at a public, multi-institutional healthcare system featuring an acute care hospital with a level I adult trauma and burn center.

Participants: We obtained retrospective data on 37 patients who underwent TAVR in our hospital system in 2022. Data was collected on their outcomes, including mortality, readmission rates and cardiovascular and cerebrovascular complications at 30 days and 1 year.

Interventions: No interventions were performed on patients as this was a retrospective study.

Measurements and main results: Patient outcomes were compared with PARTNER III trial results. There was no 30-day mortality (versus 1% in the PARTNER III trial) and a 1-year mortality rate of 2.7% (versus 8.5% in the PARTNER III trial). During the procedures, no patients were converted to general anesthesia nor actively bleeding. At 30 days, no patients were readmitted for valve-related issues.

Conclusion: This study demonstrates that lower volume healthcare institutions can achieve outcomes comparable/similar to higher volume institutions in specialized procedures like TAVR, challenging the assumption that superior outcomes are tied to institutional size. Our findings highlight the importance of quality, teamwork and individualized care in achieving excellent clinical outcomes, regardless of size.