The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study.

MedStar author(s):
Citation: Jacc: Cardiovascular Interventions. 12(5):459-469, 2019 03 11.PMID: 30846085Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Aortic Valve/su [Surgery] | *Catheterization, Peripheral | *Critical Pathways | *Femoral Artery | *Hospitals, High-Volume | *Hospitals, Low-Volume | *Length of Stay | *Patient Discharge | *Transcatheter Aortic Valve Replacement | Aged | Aged, 80 and over | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/pp [Physiopathology] | Canada | Catheterization, Peripheral/ae [Adverse Effects] | Catheterization, Peripheral/mo [Mortality] | Female | Heart Valve Prosthesis | Humans | Male | Patient Readmission | Postoperative Complications/mo [Mortality] | Postoperative Complications/th [Therapy] | Prospective Studies | Prosthesis Design | Punctures | Risk Assessment | Risk Factors | Time Factors | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Transcatheter Aortic Valve Replacement/is [Instrumentation] | Transcatheter Aortic Valve Replacement/mo [Mortality] | Treatment Outcome | United StatesYear: 2019Local holdings: Available online through MWHC library: 2008 - presentISSN:
  • 1936-8798
Name of journal: JACC. Cardiovascular interventionsAbstract: BACKGROUND: Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, hospital stays average at least 6 days in most trials. The Vancouver 3M Clinical Pathway is focused on next-day discharge, made possible by the use of objective screening criteria as well as streamlined peri- and post-procedural management guidelines.CONCLUSIONS: Adherence to the Vancouver 3M Clinical Pathway at low-, medium-, and high-volume TAVR centers allows next-day discharge home with excellent safety and efficacy outcomes. Copyright (c) 2019. Published by Elsevier Inc.METHODS: Patients were enrolled from 6 low-volume (<100 TAVR/year), 4 medium-volume, and 3 high-volume (>200 TAVR/year) centers in Canada and the United States. The primary outcomes were a composite of all-cause death or stroke by 30 days and the proportion of patients successfully discharged home the day following TAVR.OBJECTIVES: The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway.RESULTS: Of 1,400 screened patients, 411 were enrolled at 13 centers and received a SAPIEN XT (58.2%) or SAPIEN 3 (41.8%) valve (Edwards Lifesciences, Irvine, California). In centers enrolling exclusively in the study, 55% of screened patients were enrolled. The median age was 84 years (interquartile range: 78 to 87 years) with a median STS score of 4.9% (interquartile range: 3.3% to 6.8%). Next-day discharge home was achieved in 80.1% of patients, and within 48 h in 89.5%. The composite of all-cause mortality or stroke by 30 days occurred in 2.9% (95% confidence interval: 1.7% to 5.1%), with neither component of the primary outcome affected by hospital TAVR volume (p = 0.51). Secondary outcomes at 30 days included major vascular complication 2.4% (n = 10), readmission 9.2% (n = 36), cardiac readmission 5.7% (n = 22), new permanent pacemaker 5.7% (n = 23), and >mild paravalvular regurgitation 3.8% (n = 15).All authors: Al-Qoofi F, Asgar A, Babaliaros VC, Barbanti M, Barker M, Blanke P, Buller C, Cairns JA, Cheung A, Cohen DJ, Cook R, Dvir D, Fahmy P, Genereux P, Horlick E, Htun N, Humphries KH, Jue J, Klein R, Kodali S, Lauck SB, Leipsic J, Leon MB, Masson JB, Moss R, Murdoch D, Natarajan MK, Nazif T, Nickel K, Osten M, Palisaitis D, Park JE, Peterson M, Poulter R, Prakash R, Radhakrishnan S, Rondi K, Sathananthan J, Stub D, Thakkar J, Thourani V, Tyrell B, Umedaly H, Velianou JL, Webb JG, Welsh R, Wijeysundera HC, Wood DA, Ye JOriginally published: Jacc: Cardiovascular Interventions. 12(5):459-469, 2019 03 11.Fiscal year: FY2019Digital Object Identifier: Date added to catalog: 2020-02-10
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30846085 Available 30846085

Available online through MWHC library: 2008 - present

BACKGROUND: Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, hospital stays average at least 6 days in most trials. The Vancouver 3M Clinical Pathway is focused on next-day discharge, made possible by the use of objective screening criteria as well as streamlined peri- and post-procedural management guidelines.

CONCLUSIONS: Adherence to the Vancouver 3M Clinical Pathway at low-, medium-, and high-volume TAVR centers allows next-day discharge home with excellent safety and efficacy outcomes. Copyright (c) 2019. Published by Elsevier Inc.

METHODS: Patients were enrolled from 6 low-volume (<100 TAVR/year), 4 medium-volume, and 3 high-volume (>200 TAVR/year) centers in Canada and the United States. The primary outcomes were a composite of all-cause death or stroke by 30 days and the proportion of patients successfully discharged home the day following TAVR.

OBJECTIVES: The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway.

RESULTS: Of 1,400 screened patients, 411 were enrolled at 13 centers and received a SAPIEN XT (58.2%) or SAPIEN 3 (41.8%) valve (Edwards Lifesciences, Irvine, California). In centers enrolling exclusively in the study, 55% of screened patients were enrolled. The median age was 84 years (interquartile range: 78 to 87 years) with a median STS score of 4.9% (interquartile range: 3.3% to 6.8%). Next-day discharge home was achieved in 80.1% of patients, and within 48 h in 89.5%. The composite of all-cause mortality or stroke by 30 days occurred in 2.9% (95% confidence interval: 1.7% to 5.1%), with neither component of the primary outcome affected by hospital TAVR volume (p = 0.51). Secondary outcomes at 30 days included major vascular complication 2.4% (n = 10), readmission 9.2% (n = 36), cardiac readmission 5.7% (n = 22), new permanent pacemaker 5.7% (n = 23), and >mild paravalvular regurgitation 3.8% (n = 15).

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