Bleeding, Arrhythmias Dominate Periprocedural Complication Costs for TAVR

Periprocedural complications account for more than one-quarter of the non-implant-related hospital costs associated with TAVR in patients with severe aortic stenosis, according to results of a study presented at TCT 2014. This suggests even modest improvements in complication rates could yield big cost savings related to these procedures.

Suzanne J. Baron, MD, of St. Luke’s Mid America Heart Institute in Kansas City, Mo., and colleagues analyzed costs associated with 506 patients enrolled in the CoreValve US Pivotal Extreme Risk Study. Mean cost for the initial hospitalization, including physician fees and the cost of the valve itself, was $73,701. Permanent pacemaker implantation, bleeding complications and arrhythmias were major contributors to those costs (see Table).

Complications per patient represented 25% of the overall non-implant-related costs in the iliofemoral access group and 27% in the non-iliofemoral access group.

Baron told TCT Daily that those percentages are generally comparable to other TAVR studies in similar populations. “By identifying the major contributors to hospital costs (eg, bleeding and arrhythmias), heart teams can focus on these particular areas as ‘low hanging fruit’ where modest reductions in complications can have an important impact on hospital costs,” she said.

The costs associated with non-iliofemoral access are higher than those with iliofemoral access both for the implant procedure itself and subsequent hospital care. Baron said this is largely due to non-iliofemoral access procedures being performed most often in a hybrid OR instead of a cath lab, where iliofemoral procedures are done.

“To some extent, this finding reflects the higher rate of complications among patients treated via the non-iliofemoral approach but is also likely due to a combination of other factors, including a higher percentage of comorbidities in the non-iliofemoral cohort such as peripheral arterial disease and oxygen-dependent lung disease,” Baron said.

As operator experience and patient selection improve in coming years, the number — and thus cost — of complications will likely drop. Baron also noted that the availability of new lower-profile valve implants should help. Still, about 75% of the costs of hospitalization are unrelated to complications.

“As such, the greatest opportunity for decreasing the costs may come in simplifying the procedure itself — by using measures such as conscious sedation as opposed to general anesthesia, using pulmonary artery catheters in only selected patients or by encouraging early ambulation so as to decrease length of stay,” Baron said.