Cardiovascular Rounds

What's the best setting for TAVR?

by Marissa Schwartz

As TAVR volumes grow and indications expand, many programs are considering how to expand their procedural capacity. But CV leaders have a common operational question when it comes to TAVR—where should I perform the procedure? Read on to learn arguments for performing TAVR in a hybrid OR vs. a cath lab.

According to CMS’s NCD for TAVR, TAVR can be performed in either a hybrid OR or a modified sterile cath lab. The optimal choice of procedure setting is best determined individually by hospital availability and resources.

However, as procedural approaches have become less invasive (e.g., fully percutaneous, TF TAVR; use of moderate sedation as opposed to general anesthesia at experienced programs) there has been a trend in recent years for more hospitals to perform TAVR in a cath lab setting.

Beyond the clinical changes, financial considerations have also driven this shift, given the large capital investment and overhead costs of building and using a hybrid OR versus a cath lab. A 2014 study published in JACC: Cardiovascular Interventions found that TAVR performed in a cath lab, as opposed to a hybrid OR, was associated with $10,000 less in costs.

However, setting alone does not account for the entire cost savings. Other factors often common to procedures done in the cath lab—such as less invasive anesthesia modality, decreased ICU time, and reduced length of stay—also account for a large portion of the difference. We’ve summarized the predictors of cost from this study in the table below:

TAVR Chart 1

This indicates that a holistic approach to operational and clinical efficiency—whether or not that involves moving procedures to the cath lab—will yield the greatest cost benefits.

For more TAVR resources, including case studies, on-demand presentations, and benchmarks, don't miss our resource center.

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