An Optimized Assessment Pathway for Remote Patients: The Vancouver Facilitated Transcatheter Aortic Valve Implantation Program

作者：Ali Husain, Julius Jelisejevas, Andrew Chatfield, Mariama Akodad, Sandra Lauck, L. Achtem, Erin Tang, F. Zaky, Philipp Blanke, Jonathan Leipsic, Stephanie Sellers, Jian Ye, Anson Cheung, Robert Moss, David Wood, Robert Boone, David Meier, Janarthanan Sathananthan, John G. Webb · 发表于：CJC Open · 年份：2024 · DOI：10.1016/j.cjco.2024.07.001 · 被引用次数：3 · 研究领域：Cardiac Valve Diseases and Treatments、Aortic Disease and Treatment Approaches、Infective Endocarditis Diagnosis and Management

Background: Novel pathways are needed to accommodate the increasing demand for transcatheter aortic valve implantation (TAVI) and ensure equitable access. A single Vancouver Facilitated TAVI program (VFTP) based at St. Paul's and Vancouver General Hospitals was established to streamline the assessment of remote patients with severe aortic stenosis using virtual technologies. Methods: Remote patients with severe aortic stenosis who expressed difficulties traveling to complete their pre-TAVI workup were included and received prospective follow-up. Clinical and echocardiographic parameters were reported per the Valve Academic Research Consortium 3. Results: Between December 2020 and March 2023, a total of 56 remote patients were included in the VFTP. The mean patient age was 79.7 ± 9.1 years. A total of 55 patients (98%) passed the screening for candidacy; 45 patients (80%) were found suitable for transfemoral TAVI, 5 patients (9%) were directed toward surgical aortic valve replacement; 3 (5%) underwent alternative-access TAVI; and 2 patients (4%) were assigned to a watchful waiting strategy. No inpatient mortality, stroke, or major bleeding occurred in the transfemoral TAVI group, and the median hospital stay was 1 day (interquartile range, 1-2 days; range, 1-24 days). Two patients had an access-closure failure requiring surgical intervention; 1 patient had tamponade; and 4 patients had complete heart block requiring permanent pacemaker implantation. No hospital readmission had...