Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Jun 1;45(21):1904-1916.
doi: 10.1093/eurheartj/ehae147.

A streamlined pathway for transcatheter aortic valve implantation: the BENCHMARK study

Derk Frank  1   2 , Eric Durand  3 , Sandra Lauck  4 , Douglas F Muir  5 , Mark Spence  6 , Mariuca Vasa-Nicotera  7 , David Wood  4 , Francesco Saia  8 , Cristóbal A Urbano-Carrillo  9 , Damien Bouchayer  10 , Vlad Anton Iliescu  11 , Christophe Saint Etienne  12 , Florence Leclercq  13 , Vincent Auffret  14 , Lluis Asmarats  15   16 , Carlo Di Mario  17 , Aurelie Veugeois  18 , Jiri Maly  19 , Andreas Schober  20   21 , Luis Nombela-Franco  22 , Nikos Werner  23 , Joan Antoni Gómez-Hospital  24 , Julia Mascherbauer  25 , Giuseppe Musumeci  26 , Nicolas Meneveau  27 , Thibaud Meurice  28 , Felix Mahfoud  29 , Federico De Marco  30 , Tim Seidler  31   32   33 , Florian Leuschner  34 , Patrick Joly  35 , Jean-Philippe Collet  36 , Ferdinand Vogt  37 , Emilio Di Lorenzo  38 , Elmar Kuhn  39 , Vicente Peral Disdier  40 , Violetta Hachaturyan  41 , Claudia M Lüske  41 , Radka Rakova  42 , Wilbert Wesselink  42 , Jana Kurucova  42 , Peter Bramlage  41 , Gemma McCalmont  5   43 ; BENCHMARK Investigator Group
Collaborators, Affiliations
Multicenter Study

A streamlined pathway for transcatheter aortic valve implantation: the BENCHMARK study

Derk Frank et al. Eur Heart J. .

Abstract

Background and aims: There is significant potential to streamline the clinical pathway for patients undergoing transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate the effect of implementing BENCHMARK best practices on the efficiency and safety of TAVI in 28 sites in 7 European countries.

Methods: This was a study of patients with severe symptomatic aortic stenosis (AS) undergoing TAVI with balloon-expandable valves before and after implementation of BENCHMARK best practices. Principal objectives were to reduce hospital length of stay (LoS) and duration of intensive care stay. Secondary objective was to document patient safety.

Results: Between January 2020 and March 2023, 897 patients were documented prior to and 1491 patients after the implementation of BENCHMARK practices. Patient characteristics were consistent with a known older TAVI population and only minor differences. Mean LoS was reduced from 7.7 ± 7.0 to 5.8 ± 5.6 days (median 6 vs. 4 days; P < .001). Duration of intensive care was reduced from 1.8 to 1.3 days (median 1.1 vs. 0.9 days; P < .001). Adoption of peri-procedure best practices led to increased use of local anaesthesia (96.1% vs. 84.3%; P < .001) and decreased procedure (median 47 vs. 60 min; P < .001) and intervention times (85 vs. 95 min; P < .001). Thirty-day patient safety did not appear to be compromised with no differences in all-cause mortality (0.6% in both groups combined), stroke/transient ischaemic attack (1.4%), life-threatening bleeding (1.3%), stage 2/3 acute kidney injury (0.7%), and valve-related readmission (1.2%).

Conclusions: Broad implementation of BENCHMARK practices contributes to improving efficiency of TAVI pathway reducing LoS and costs without compromising patient safety.

Keywords: Aortic stenosis; Clinical care; Health services; Prospective registry; Quality of care; TAVI; Transcatheter aortic valve implantation.

PubMed Disclaimer

Figures

Structured Graphical Abstract
Structured Graphical Abstract
BENCHMARK: streamlined transcatheter aortic valve implantation (TAVI) pathway with retained safety. CCU, coronary care unit; ICU, intensive care unit; GW, general ward; IMC, intermediate care; PPM, permanent pacemaker. *Includes patients with available data on LoS only.
Figure 1
Figure 1
BENCHMARK best practices implementation rate. PPI, permanent pacemaker implantation
Figure 2
Figure 2
Results for the primary objective: hospital length of stay broken down into door to needle and needle to door (A) and length of ICU, CCU, IMC, and general ward stay (B). ICU, intensive care unit; CCU, coronary care unit; IMC, intermediate care; GW, general ward
Figure 3
Figure 3
Improvement in quality of life based on TASQ (A) and patient satisfaction with the BENCHMARK approach (B). TASQ, Toronto Aortic Stenosis Questionnaire; FU, follow-up
See this image and copyright information in PMC

References

    1. Vendrik J, Vlastra W, van Mourik MS, Delewi R, Beijk MA, Lemkes J, et al. Early mobilisation after transfemoral transcatheter aortic valve implantation: results of the MobiTAVI trial. Neth Heart J 2020;28:240–8. 10.1007/s12471-020-01374-5 - DOI - PMC - PubMed
    1. Lauck SB, Wood DA, Baumbusch J, Kwon JY, Stub D, Achtem L, et al. Vancouver transcatheter aortic valve replacement clinical pathway: minimalist approach, standardized care, and discharge criteria to reduce length of stay. Circ Cardiovasc Qual Outcomes 2016;9:312–21. 10.1161/CIRCOUTCOMES.115.002541 - DOI - PubMed
    1. Barbanti M, Capranzano P, Ohno Y, Attizzani GF, Gulino S, Imme S, et al. Early discharge after transfemoral transcatheter aortic valve implantation. Heart 2015;101:1485–90. 10.1136/heartjnl-2014-307351 - DOI - PubMed
    1. Aldalati O, Keshavarzi F, Kaura A, Byrne J, Eskandari M, Deshpande R, et al. Factors associated with safe early discharge after transcatheter aortic valve implantation. Cardiol J 2018;25:14–23. 10.5603/CJ.a2017.0087 - DOI - PubMed
    1. Alkhalil A, Lamba H, Deo S, Bezerra HG, Patel SM, Markowitz A, et al. Safety of shorter length of hospital stay for patients undergoing minimalist transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2018;91:345–53. 10.1002/ccd.27230 - DOI - PubMed

Publication types

LinkOut - more resources