Great Western Hospitals NHS Foundation Trust, Swindon, UK
Royal Brompton & Harefield NHS Foundation Trust, London, UK.
Open Heart. 2023 Sep;10(2). doi: 10.1136/openhrt-2022-002170.
Severe aortic stenosis is a major cause of morbidity and mortality. The existing treatment pathway for transcatheter aortic valve implantation (TAVI) traditionally relies on tertiary Heart Valve Centre workup. However, this has been associated with delays to treatment, in breach of British Cardiovascular Intervention Society targets. A novel pathway with emphasis on comprehensive patient workup at a local centre, alongside close collaboration with a Heart Valve Centre, may help reduce the time to TAVI.
The centre performing local workup implemented a novel TAVI referral pathway. Data were collected retrospectively for all outpatients referred for consideration of TAVI to a Heart Valve Centre from November 2020 to November 2021. The main outcome of time to TAVI was calculated as the time from Heart Valve Centre referral to TAVI, or alternative intervention, expressed in days. For the centre performing local workup, referral was defined as the date of multidisciplinary team discussion. For this centre, a total pathway time from echocardiographic diagnosis to TAVI was also evaluated. A secondary outcome of the proportion of referrals proceeding to TAVI at the Heart Valve Centre was analysed.
Mean±SD time from referral to TAVI was significantly lower at the centre performing local workup, when compared with centres with traditional referral pathways (32.4±64 to 126±257 days, p<0.00001). The total pathway time from echocardiographic diagnosis to TAVI for the centre performing local workup was 89.9±67.6 days, which was also significantly shorter than referral to TAVI time from all other centres (p<0.003). Centres without local workup had a significantly lower percentage of patients accepted for TAVI (49.5% vs 97.8%, p<0.00001).
A novel TAVI pathway with emphasis on local workup within a non-surgical centre significantly reduced both the time to TAVI and rejection rates from a Heart Valve Centre. If adopted across the other centres, this approach may help improve access to TAVI.
严重的主动脉瓣狭窄是发病率和死亡率的主要原因。经导管主动脉瓣植入术（TAVI）的现有治疗途径传统上依赖于三级心脏瓣膜中心的评估。然而，这与治疗的延迟有关，违反了英国心血管介入学会的目标。一种强调在当地中心进行全面患者评估，并与心脏瓣膜中心密切合作的新途径，可能有助于缩短 TAVI 的时间。
进行本地评估的中心实施了一种新的 TAVI 转诊途径。从 2020 年 11 月至 2021 年 11 月，回顾性收集了所有因考虑接受 TAVI 治疗而向心脏瓣膜中心转诊的门诊患者的数据。TAVI 的时间是主要结果，计算为从心脏瓣膜中心转诊到 TAVI 或替代干预的时间，以天数表示。对于进行本地评估的中心，转诊定义为多学科团队讨论的日期。对于该中心，还评估了从超声心动图诊断到 TAVI 的总途径时间。分析了心脏瓣膜中心进行转诊的比例的次要结果。
与传统转诊途径相比，在进行本地评估的中心，从转诊到 TAVI 的平均时间明显更短（32.4±64 至 126±257 天，p<0.00001）。进行本地评估的中心从超声心动图诊断到 TAVI 的总途径时间为 89.9±67.6 天，也明显短于所有其他中心的转诊至 TAVI 时间（p<0.003）。没有本地评估的中心接受 TAVI 的患者比例明显较低（49.5%对 97.8%，p<0.00001）。
一种强调非手术中心进行本地评估的新型 TAVI 途径，显著缩短了 TAVI 的时间和从心脏瓣膜中心的拒绝率。如果在其他中心采用这种方法，可能有助于改善 TAVI 的获得途径。
