Costs Associated with Routine Intensive Care Unit Admission after Transfemoral Transcatheter Aortic Valve Implantation with Balloon Expandable Valve

Finn, Matthew

Costs Associated with Routine Intensive Care Unit Admission after Transfemoral Transcatheter Aortic Valve Implantation with Balloon Expandable Valve

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Matthew T Finn, M.D. , Columbia University Medical Center, New York, NY

Hemal Gada, M.D. , Pinnacle Health Cardiovascular Institute, Wormleysburg, PA

Deepa Kumaraiah, MD MBA , Columbia University Medical Center, New York, NY

Shmuel ` Chen, MD PhD , Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY

Akriti Gupta, MD , Columbia University Medical Center, New York, NY

Katherine Chau, MD , Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY

Jacob Cleman, MD , Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY

Matthew Brinkman , Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY

Tiffany Wong, PA-C , Columbia University Medical Center, New York, NY

Maria Alu, MM , Columbia University Medical Center, New York, NY

Amisha Patel, M.D. , Columbia University Medical Center, New York, NY

Omar Khalique, M.D. , Columbia University Medical Center, New York, NY

Rebecca Tung Hahn, M.D. , Columbia Presbyterian Hospital, New York, NY

Isaac George, MD , Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY

Vinayak Bapat, MD , Columbia University Medical Center, New York, NY

Ajay J. Kirtane, M.D., FSCAI , Columbia University Medical Center, Demarest, NJ

Susheel K. Kodali, M.D. , New York Presbyterian Hospital, Columbia Campus, New York, NY

Martin B. Leon, M.D., FSCAI , Columbia University Medical Center, New York, NY

Tamim M. Nazif, M.D., FSCAI , Columbia University Medical Center, Scarsdale, NY

Background
Patients undergoing Transcatheter Aortic Valve Replacement (TAVR) may be routinely admitted to an intensive care unit (ICU) for post-procedure care. We analyzed patients receiving “Fast-Track” (FT) recovery (direct admission from post-procedure recovery to a telemetry floor) compared to propensity matched controls who received routine ICU care.

Methods
Consecutive patients undergoing transfemoral TAVR were recorded in a single center database. Patients were excluded based on the following criteria when exiting the procedure suite: major intra-procedural complication, ongoing vasoactive IV medication use, new significant neurologic deficit, positive pressure ventilation in recovery, temporary pacemaker requirement, or new significant conduction defect (new left bundle branch block or complete heart block).

Results
From 2014 to 2016, 345 patients met study criteria with 138 patients (40.0%) included in the FT pathway. The rate of escalation of care to the ICU once assigned to the FT group was 8.7%. The most common reasons for ICU upgrade were hypertension requiring IV medications (50%, n=6/12) or late bradycardia (16.7%, n=2/12). After propensity score matching, length of stay and mean inpatient costs were significantly lower in the FT group compared to the routine ICU care group (2 vs. 3 days, p < 0.001 and $47,408 vs. $51,768, p = 0.048). 30-day clinical outcomes in the matched groups were similar and are shown in the figure.

Conclusions
In selected patients undergoing TAVR, a FT pathway leads to shorter length of stay and reduced inpatient costs without differences in 30-day death or rehospitalization.