A streamlined pathway for transcatheter aortic valve implantation: the BENCHMARK study
Authors: Frank Derk , Durand Eric , Lauck Sandra , Muir Douglas F , Spence Mark , Vasa-Nicotera Mariuca , Wood David , Saia Francesco , Urbano-Carrillo Cristóbal A , Bouchayer Damien , Iliescu Vlad Anton , Saint Etienne Christophe , Leclercq Florence , Auffret Vincent , Asmarats Lluis , Di Mario Carlo , Veugeois Aurelie , Maly Jiri , Schober Andreas , Nombela-Franco Luis , Werner Nikos , Gómez-Hospital Joan Antoni , Mascherbauer Julia , Musumeci Giuseppe , Meneveau Nicolas , Meurice Thibaud , Mahfoud Felix , De Marco Federico , Seidler Tim , Leuschner Florian , Joly Patrick , Collet Jean-Philippe , Vogt Ferdinand , Di Lorenzo Emilio , Kuhn Elmar , Disdier Vicente Peral , Hachaturyan Violetta , Lüske Claudia M , Rakova Radka , Wesselink Wilbert , Kurucova Jana , Bramlage Peter , McCalmont Gemma ,   for the BENCHMARK Investigator Group, Frank Derk , McCalmont Gemma , Bramlage Peter , Lüske Claudia M , Zielinski Marie , Greinert Daniel , Deutsch Cornelia , Hachaturyan Violetta , Durand Eric , Lauck Sandra , Muir Douglas , Spence Mark , Vasa-Nicotera Mariuca , Wood David , Saia Francesco , Kurucova Jana , Wesselink Wilbert , Rakova Radka , Thoenes Martin , Urbano-Carrillo Cristóbal A , García Carlos Lara , Chamorro Beatriz , Bouchayer Damien , Claudel Jean-Philippe , Perrier Hervé , Frebault Viktoria , Iliescu Vlad Anton , Parasca Catalina Andreea , Etienne Christophe Saint , Lassouani Katia , Leclercq Florence , Zitouni Wassim , Soltani Sonia , Auffret Vincent , Gal Rosalie Le , Asmarats Lluis , Xarrie Elena Jimenez , Di Mario Carlo , Ciardetti Niccolo , Meucci Francesco , Veugeois Aurelie , Bagdadi Imane , Maly Jiri , Kolinova Lenka , Schober Andreas , Delle-Karth Georg , Schuster Claudia , Leitgeb Marie-Christine , Nombela-Franco Luis , García Esther Bernardo , Pozzi María Aránzazu Ortega , Werner Nikos , Leick Jürgen , Lauterbach Michael , Waschbüsch Hannah , Antoni Joan , Muntané Guillem , Daxböck Julia Mascherbauer Olga , Butkovic Mirela , Popescu Simona , Musumeci Giuseppe , Perrero Martina , Meneveau Nicolas , Watbled Stephanie , Meurice Thibaud , Delomez Maxence , Mahfoud Felix , Scheller Bruno , Ewen Sebastian , Berger Ann-Kathrin , Koch Christina , Engel Alexandra , De Marco Federico , Olivares Paolo , Seidler Tim , Wolf Frieder , Müller Carolin , Hünermund Maren , Leuschner Florian , Konstandin Mathias , Linz Lisa , Ulbricht Hannah , Joly Patrick , Siame Sabrina , Collet Jean-Philippe , Amrane Nassima Ait , Vogt Ferdinand , Rosenzweig Dow , Di Lorenzo Emilio , Cefalo Barbara , Kuhn Elmar , Wolf Vera , Disdier Vicente Peral , Daunert Jaume Maristany , de la Bandera Sanchez Maria Carmen 
Published: March 2024

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 &lt; .001). Duration of intensive care was reduced from 1.8 to 1.3 days (median 1.1 vs. 0.9 days; P &lt; .001). Adoption of peri-procedure best practices led to increased use of local anaesthesia (96.1% vs. 84.3%; P &lt; .001) and decreased procedure (median 47 vs. 60 min; P &lt; .001) and intervention times (85 vs. 95 min; P &lt; .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.