Resource utilization and procedure-related costs associated with transfemoral transcatheter aortic valve replacement

Figures & data

Table 1. Baseline characteristics—BE vs SE valve groups.

Parameter	BE valve (n = 100)		SE valve (n = 95)		p-value
	n/N	%	n/N	%
Gender, female	64/100	64	51/95	53.7	.143
Age, years	82.37 ± 5.9		83.6 ± 4.95		.116
EuroSCORE I^a, %	19.85 ± 15.18		21 ± 13.61		.578
NYHA FC III/IV^b	54/77	70.1	68/82	82.9	.056
BMI, kg/m^2	27.54 ± 5.9		25.3 ± 3.87		.002
Previous MI	16/100	16	18/95	18.9	.588
MI (90 days)	12/100	12	7/95	7.4	.276
Porcelain aorta^b	5/84	6	2/19	10.5	.474
Active endocarditis	0/100	0	0/95	0
COPD	21/100	21	22/95	23.2	.716
Diabetes type 2:
Insulin treated	15/100	15	14/95	14.7	.567
Non-insulin treated	18/100	18	12/95	12.6
Dialysis	3/100	3	5/95	5.3	.426
Pacemaker^b	2/20	10	5/43	11.6	.848
Cardiovascular surgeries	17/100	17	23/95	24.2	.213
Previous aortic bioprosthetic valve replacement	0/100	0	6/95	6.3	.011
Aortic annulus diameter^b	23.56 ± 2.3 (n = 87)		22.72 ± 3.75 (n = 18)		.371
EOA^b, cm^2	4.37 ± 0.78 (n = 91)		4.34 ± 0.95 (n = 36)		.861
Hyperlipidemia	70/100	70	65/95	68.4	.811
Pulmonary hypertension	45/100	45	36/95	37.9	.314
Smoker
Current	4/100	4	2/95	2.1	.713
Past	12/100	12	13/95	13.7
Cancer (current or history)	0/100	0	0/95	0	.72
Angina CCS^b
I	2/45	4.4	5/35	14.3	.293
II	7/45	15.6	8/35	22.9
III	5/45	11.1	4/35	11.4
IV	31/45	68.9	18/35	51.4

Values are mean ± standard deviation or n/N (%).

^a The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is a measure of patient risk of mortality after cardiac surgery. A EuroSCORE higher than 20% indicates very high surgical risk.

^b Data were not available for all patients for these parameters.

Angina CCS: Canadian Cardiovascular Society grading of angina pectoris; BE: Balloon-expandable; BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; EOA: Effective orifice area; MI: Myocardial infarction; n/N: Number of patients with the specified characteristic/total number of patients with data available; NYHA FC: New York Heart Association function class; SE: Self-expandable.

Table 2. Procedural parameters—BE vs SE valve groups.

Parameter^a	BE valve (n = 100)		SE valve (n = 95)		p-value
	n/N	%	n/N	%
Procedure location
Catheterization laboratory	0/100	0	78/95	82.1	<.001
Hybrid operating room	100/100	100	17/95	17.9
Fluoroscopy time, min	15.5 ± 8.74		19.4 ± 11.2		.008
Cumulative time physicians, min	273 ± 146		360 ± 188		<.001
Number of physicians	2.04 ± 0.42		2.05 ± 0.57		.862
Cumulative time nurses, min	243 ± 121		312 ± 164		.001
Number of nurses	2.78 ± 0.6		2.68 ± 0.78		.337
Total procedure time, min	88.4 ± 39.7		115 ± 42.9		<.001
Volume of contrast used, ml	285 ± 80 (n = 13)		180 ± 125 (n = 34)		.002

Values are mean ± standard deviation or n/N (%).

^a Time and number of personnel are per procedure.

BE: Balloon-expandable; n/N: Number of patients with the specified characteristic/total number of patients with data available; SE: Self-expandable.

Table 3. Post-procedural parameters—BE vs SE valve groups.

Parameter	BE valve (n = 100)		SE valve (n = 95)		p-value
	n/N	%	n/N	%
Death (30 days)	3/100	3	8/95	8.4	.101
New PM	31/98	31.6	38/90	42.2	.132
Cumulative time of new PM procedure, min	85.9 ± 24.06		98.74 ± 26.99		.041
Dialysis during hospitalization	2/100	2	3/95	3.2	.609
Dialysis during hospitalization, mean ± SD	3 ± 1.41		4.67 ± 1.53		.318
Mechanical ventilation >24 h	6/100	6	2/95	2.1	.171
Duration of mechanical ventilation >24 h, h	73 ± 49.6		293.5 ± 256.68		.437
Blood transfusion	26/100	26	35/95	36.8	.103
Vascular complications	9/100	9	5/95	5.3	.312
LoS ICU, days	2.51 ± 2.04		3.56 ± 2.86		.004
Post-op LoS ward, days	6.27 ± 3.34		7.26 ± 5.25		.119
Total LoS (not incl. pre-op), days	8.69 ± 3.81		11.11 ± 5.53		.001

Values are mean ± standard deviation or n/N (%).

BE: Balloon-expandable; ICU: Intensive care unit; LoS: Length of stay; n/N: Number of patients with the specified characteristic/total number of patients with data available; PM: Pacemaker; SD: Standard deviation; SE: Self-expandable.

Table 4. Costs BE vs SE valve groups.

Costs	Percentage increase in procedural costs (using the SE valve)^a	p-value for change
Pre-operative	19.2	.027
Physicians	31.8	<.001
Nurses	28.2	.001
Catheterization laboratory/ Hybrid operating room	29.6	<.001
ICU	41.9	.004
Ward	7.8	.327
Infrastructure/admin/other	16.8	.035
Total procedural costs (excl valve costs)	24.4	<.001

^a Calculated as ([Mean costs SE valve group – Mean costs BE valve group]/Mean costs BE valve group) * 100

BE: Balloon-expandable; ICU: Intensive care unit; SE: Self-expandable.