1
|
Kermanshahchi J, Thind B, Davoodpour G, Hirsch M, Chen J, Reddy AJ, Yu Z, Falkenstein BE, Javidi D. Transcatheter Aortic Valve Replacement (TAVR) Versus Surgical Aortic Valve Replacement (SAVR): A Review on the Length of Stay, Cost, Comorbidities, and Procedural Complications. Cureus 2024; 16:e54435. [PMID: 38510891 PMCID: PMC10951673 DOI: 10.7759/cureus.54435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
This review provides an in-depth analysis of the effect of length of stay (LOS), comorbidities, and procedural complications on the cost-effectiveness of transcatheter aortic valve replacement (TAVR) in comparison to surgical aortic valve replacement (SAVR). We found that the average LOS was shorter for patients undergoing TAVR, contributing to lower average costs associated with the procedure, although the LOS varied between patients due to the severity of illness and comorbidities present. TAVR has also been found to improve the quality of life for patients receiving aortic valve replacement compared to SAVR. Although TAVR has a lower rate of most post-operative complications caused by SAVR, such as bleeding and cardiac complications, TAVR shows an increased rate of permanent pacemaker (PPM) implantation due to mechanical trauma on the heart's conduction system. In addition, our findings suggest that the cost-effectiveness of each procedure varies based on the types of valve, the patient history of other medical conditions, and the procedural methods. Our findings show that TAVR is preferred over SAVR in terms of cost-effectiveness across a variety of patients with other coexisting medical conditions, including cancer, advanced kidney disease, cirrhosis, diabetes mellitus, and bundle branch block. TAVR also appears to be superior to SAVR with fewer post-operative complications. However, TAVR appears to have a higher rate of PPM implantation rates as compared to SAVR. The comorbidities of the valve recipient must be considered when deciding whether to use TAVR or SAVR as cost-effectiveness varies with the patient background.
Collapse
Affiliation(s)
| | - Birpartap Thind
- Medicine, California University of Science and Medicine, Colton, USA
| | | | - Megan Hirsch
- Medicine, California University of Science and Medicine, Colton, USA
| | - Jeff Chen
- Medicine, California University of Science and Medicine, Colton, USA
| | - Akshay J Reddy
- Medicine, California University of Science and Medicine, Colton, USA
| | - Zeyu Yu
- College of Medicine, California Health Sciences University, Clovis, USA
| | | | - Daryoush Javidi
- Medical Education, California University of Science and Medicine, Colton, USA
| |
Collapse
|
2
|
Wei K, Xie X, Huang T, Chen Y, Zhang H, Liu T, Luo J. Drug closed-loop management system using mobile technology. BMC Med Inform Decis Mak 2022; 22:311. [PMID: 36443815 PMCID: PMC9703708 DOI: 10.1186/s12911-022-02067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Drug closed-loop management reflects the level of hospital management and pharmacist service. It is a challenge for hospital pharmacists to realize the whole-process closed-loop management of drugs in hospital pharmacies. Therefore, this study aimed to evaluate the operational effect of using mobile technology to build a closed-loop drug management system. METHODS Using mobile technology, replacing the traditional paper dispensing model and constructing a multinode information collection system according to the Healthcare Information and Management Systems Society Standard, we reformed the hospital information system and inpatient pharmacy workflow and then evaluated the new approach using statistical methods. RESULTS After the transformation, the entire process of drug data can be traced. Closed-loop management, as well as real-time data verification and control, thereby improves the work efficiency and reduces the drug dispensing time. By reducing the work error rate, the number of dispensing errors decreased from 5 to 1 case/month. The comprehensive dispensing process can achieve the whole workflow of paperless operation and reduce the use of paper A4 by 180,000 pieces per year. CONCLUSIONS Mobile technology can improve the service level of pharmacies, enhance the level of drug management and hospital quality management, ensure the safety of medication for inpatients, and significantly reduce the amount of paper used.
Collapse
Affiliation(s)
- Kunxuan Wei
- grid.412594.f0000 0004 1757 2961Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Xuhua Xie
- grid.412594.f0000 0004 1757 2961Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Tianmin Huang
- grid.412594.f0000 0004 1757 2961Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Yiyu Chen
- grid.412594.f0000 0004 1757 2961Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Hongliang Zhang
- grid.412594.f0000 0004 1757 2961Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Taotao Liu
- grid.412594.f0000 0004 1757 2961Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Jun Luo
- grid.412594.f0000 0004 1757 2961Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| |
Collapse
|
3
|
Bui HT, Ishrat A, James SP, Dasi LP. Design consideration of a novel polymeric transcatheter heart valve through computational modeling. J Mech Behav Biomed Mater 2022; 135:105434. [PMID: 36116342 DOI: 10.1016/j.jmbbm.2022.105434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/23/2022] [Accepted: 08/28/2022] [Indexed: 11/29/2022]
Abstract
Transcatheter heart valve replacement is becoming a more routine procedure, and this is further supported by positive outcomes from studies involving low-risk patients. Nevertheless, the lack of long-term transcatheter heart valve (TAV) durability is still one of the primary concerns. As a result, more research has been focused on improving durability through various methods such as valve design, computational modeling, and material selection. Recent advancements in polymeric valve fabrication showed that linear low-density polyethylene (LLDPE) could be used as leaflet material for transcatheter heart valves. In this paper, a parametric study of computational simulations showed stress distribution on the leaflets of LLDPE-TAV under diastolic load, and the results were used to improve the stent design. The in silico experiment also tested the effect of shock absorbers in terms of valve durability. The results demonstrated that altering specific stent angles can significantly lower peak stress on the leaflets (13.8 vs. 6.07 MPa). Implementing two layers of shock absorbers further reduces the stress value to 4.28 MPa. The pinwheeling index was assessed, which seems to correlate with peak stress. Overall, the parametric study and the computational method can be used to analyze and improve valve durability.
Collapse
Affiliation(s)
- Hieu T Bui
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Cir NW, Atlanta, GA, 30313, USA
| | - Amina Ishrat
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Cir NW, Atlanta, GA, 30313, USA
| | - Susan P James
- School of Advanced Materials Discovery, Colorado State University, 700 Meridian Ave, Fort Collins, CO, 80523, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Cir NW, Atlanta, GA, 30313, USA.
| |
Collapse
|
4
|
Reddy KP, Groeneveld PW, Giri J, Fanaroff AC, Nathan AS. Economic Considerations in Access to Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2022; 15:e011489. [PMID: 35021854 DOI: 10.1161/circinterventions.121.011489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, with the number of procedures and sites offering the procedure steadily rising over the past decade in the United States. Despite this, growth into certain markets has been limited as hospitals have to balance high TAVR costs with the ability to offer a complete array of state-of-the-art therapies for aortic stenosis. This trade-off often results in decreased access to TAVR services by patients cared for in hospitals that cannot afford these services or have difficulty meeting procedural requirements, recruiting skilled physicians, and initiating and then maintaining a functioning TAVR program. The lack of access is more common among patients of color or those who are socioeconomically disadvantaged. The purpose of this review is to describe the hospital-level economic considerations of TAVR in the United States and the resulting effects on geographic, racial, ethnic, and socioeconomic access for Americans.
Collapse
Affiliation(s)
- Kriyana P Reddy
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (K.P.R., P.W.G., J.G., A.C.F., A.S.N.), University of Pennsylvania, Philadelphia
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (K.P.R., P.W.G., J.G., A.C.F., A.S.N.), University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics (P.W.G., J.G., A.C.F., A.S.N.), University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (P.W.G., J.G., A.S.N.)
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (K.P.R., P.W.G., J.G., A.C.F., A.S.N.), University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics (P.W.G., J.G., A.C.F., A.S.N.), University of Pennsylvania, Philadelphia.,Cardiovascular Division (J.G., A.C.F., A.S.N.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alexander C Fanaroff
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (K.P.R., P.W.G., J.G., A.C.F., A.S.N.), University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics (P.W.G., J.G., A.C.F., A.S.N.), University of Pennsylvania, Philadelphia.,Cardiovascular Division (J.G., A.C.F., A.S.N.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ashwin S Nathan
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (K.P.R., P.W.G., J.G., A.C.F., A.S.N.), University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics (P.W.G., J.G., A.C.F., A.S.N.), University of Pennsylvania, Philadelphia.,Cardiovascular Division (J.G., A.C.F., A.S.N.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (P.W.G., J.G., A.S.N.)
| |
Collapse
|
5
|
Bui HT, Khair N, Yeats B, Gooden S, James SP, Dasi LP. Transcatheter Heart Valves: A Biomaterials Perspective. Adv Healthc Mater 2021; 10:e2100115. [PMID: 34038627 DOI: 10.1002/adhm.202100115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/23/2021] [Indexed: 11/11/2022]
Abstract
Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high-risk patients. The latest clinical data demonstrates that THVR is a practical solution for low-risk patients. Despite these promising results, there is no long-term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long-term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.
Collapse
Affiliation(s)
- Hieu T. Bui
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Nipa Khair
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Breandan Yeats
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Shelley Gooden
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Susan P. James
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| |
Collapse
|
6
|
Okoh AK, Siddiqui E, Soto C, Dhaduk N, Hirji S, Tayal R, Chen C, Lee LY, Russo MJ. Trends in Early Discharge and Associated Costs after Transcatheter Aortic Valve Replacement: A National Perspective. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:373-378. [PMID: 34134552 DOI: 10.1177/15569845211013355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The current study aims to report trends of early discharges and identify associated direct costs using a nationally representative database of real-world data experience. METHODS We used nationally weighted data on all patients who had transfemoral transcatheter aortic valve replacement (TAVR) from 2012 to 2017 and discharged alive from the National Inpatient Sample. Patients were divided into early (discharge ≤3 days of admission) and late discharge. Demographics and clinical characteristics were compared. Trends in early discharge and costs associated with admissions were analyzed over the study period. RESULTS Of the 125,188 patients identified, 59,424 (46.9%) were discharged early. The proportion of early discharge increased from 15% in early 2012 to 68% in late 2017 (P < 0.001), with the largest increase occurring from 2014 to 2015. Overall, the average cost of TAVR decreased from $58,408 in 2012 to $49,875 in 2017 (P < 0.001). Compared to late discharge, patients discharged early reported costs savings of ≥$20,000 over the study period. Among the early discharge group, no significant differences in costs were observed for patients discharged on 0 to 1, 2, or 3 days after the procedure. CONCLUSIONS Postoperative length of stay after TAVR has decreased dramatically within the last decade with an observed reduction in procedural costs. While discharge within 3 days appeared cost effective, no differences in costs were noted among patients discharged ≤3 days.
Collapse
Affiliation(s)
- Alexis K Okoh
- 43982 Heart and Lung Research Center, Rutgers Health, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA.,459812287 Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Emaad Siddiqui
- 214907 Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Cassandra Soto
- 459812287 Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nehal Dhaduk
- 43982 Heart and Lung Research Center, Rutgers Health, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Sameer Hirji
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rajiv Tayal
- 43982 Heart and Lung Research Center, Rutgers Health, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Chunguang Chen
- 43982 Heart and Lung Research Center, Rutgers Health, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA.,459812287 Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Leonard Y Lee
- 459812287 Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Mark J Russo
- 459812287 Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| |
Collapse
|