title: Transfemoral aortic valve implantation: bleeding events, related costs and outcomes.
abstract: Although less invasive then SAVR, TAVI is associated with a significant rate of access site and non-access site bleeding. These complications are major determinants of therapy outcome, however, the economic consequences are not well defined. The purpose of this study was to determine the relationship between bleeding, in-hospital resource utilization and costs among patients undergoing transfemoral aortic valve implantation (TF-AVI) at a representative university hospital in Germany. Between February 2010 and December 2011, we prospectively enrolled 60 consecutive patients undergoing TAVI using a 18F transfemoral approach at our institution. The relationship between overt bleeding (OVB), defined according to the definitions provided by the Valve Academic Research Consortium, in-hospital resource utilization and in-hospital costs was investigated. The mean age was 82 (±6) years, 53% were female and the mean EuroScore was 17.2% (±8, 7). Thirty-eight percent (23/60) of the patients had an OVB following TF-AVI procedure. In-hospital mortality was 8.7% in the OVB patients (2/23) and 2.7% among patients without any OVB (1/37; NOVB), which was not statistically significant (p = 0.3). The total length of stay (LOS) of patients with and without bleeding complication were 15.0 ± 6.4 and 10.4 ± 5.1 days, respectively (p < 0.01). Time spent on ICU in the OVB group was twice as long as compared to the NOVB group (120.5 ± 98.5 min vs. 63.6 ± 26.5 min, p < 0.01). Consequently, in-hospital costs were statistically significant higher in OVB patients (40.051 ± 9.293<euro> vs. 33.625 ± 4.368<euro>, p < 0.01). Bleeding is associated with increased resource use and in-hospital costs among TF-AVI patients. Our data indicates that strategies reducing bleeding risk may have the potential to generate important in-hospital costs reductions in TF-AVI patients.
authors.affiliation: Department of Cardiology, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany. jochen.reinoehl@universitaets-herzzentrum.de
authors.forename: Jochen
authors.initials: J
authors.lastname: Reinöhl
authors.forename: Anja
authors.initials: A
authors.lastname: Gutmann
authors.forename: Marc
authors.initials: M
authors.lastname: Kollum
authors.forename: Constantin
authors.initials: C
authors.lastname: von Zur Mühlen
authors.forename: Hardy
authors.initials: H
authors.lastname: Baumbach
authors.forename: Melanie
authors.initials: M
authors.lastname: Avlar
authors.forename: Martin
authors.initials: M
authors.lastname: Moser
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
authors.forename: Manfred
authors.initials: M
authors.lastname: Zehender
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000191:economics / Q000401:mortality / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods; D003365:Costs and Cost Analysis; D005260:Female; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000191:economics / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors