Viability of a Transcatheter Aortic Valve Implantation (TAVI) Program in a private hospital: a comparison of two Victorian hospitals.

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has become an accepted treatment for patients with symptomatic, severe aortic stenosis with increased surgical risk. Currently there are many public hospitals performing TAVI, yet, due to limited funding, there are few private hospitals performing TAVI. This study aims to compare the TAVI programs at the publicly funded Alfred Hospital (AH), and the private Epworth Hospital (EH). Methods: We performed a prospective observational study from August 2008 to October 2017. The same multidisciplinary team was involved in case selection and performing the procedure at both sites, complying with the CSANZ TAVI position statement. VARC-2 definitions were used. Results: TAVI was performed on 335 (55%) patients at AH, and 276 (45%) at EH. EH had an older population (AH 83±7 vs. EH 85±5 years, p<0.001) with a higher NYHA class (AH 2.5 [IQR ,2.0, 3.0] vs. EH 3.0 [IQR, 2.0, 3.0], p=0.04). Both cohorts had similar STS scores (AH 5.0±3.8 vs. EH 5.0±2.8, p=0.78). Both cohorts had similar length of stay (AH 6±3 vs. EH 6±4 days, p=0.104) and one-month post-procedure NYHA class (AH 1.0 [IQR,1.0, 2.0] vs. EH 1.0 [IQR,1.0, 2.0], p=0.55). One-month mortality was similar (AH 1.5% vs. EH 1.1%, p=0.63), but EH patients had a higher one-year mortality (AH 4.5% vs. EH 8.6%, p=0.04). However, long-term overall Kaplan-Meier survival curve was similar between cohorts (p=0.20). Conclusion: Both public and private hospitals delivered comparable outcomes over both short- and long-term. These data support the establishment of successful TAVI programs, in both funding systems.