The Pipeline

ACC 2014: Promising future for TAVR’s efficacy and LOS

Jake Kahane, Service Line Strategy Advisor

This year’s ACC conference reviewed the latest in cardiovascular service advancement. Below we highlight one of four key takeaways for our coverage of this year’s scientific session.

The future of the TAVR technology and the device’s cost-effectiveness were topics of high importance at ACC this year. Here, we highlight the key takeaways from ACC’s late-breaking TAVR trials and sessions on how to make your TAVR program profitable.

Surprising trial results support promising future for TAVR technology

Two late breaking trials at ACC this year presented findings that may have a major impact on your valve program.

First, impressive results from the CoreValve High-Risk trial demonstrated superiority of Medtronic’s CoreValve TAVR device over surgical valve replacement for its primary endpoint, all-cause mortality at one-year. The surprising results signal that improving TAVR technology and operator experience may lead heart teams to consider TAVR for more patients requiring aortic valve replacement, cutting into surgery’s share of the market. While questions remain regarding the long-term durability of TAVR devices, these results make the procedure a more attractive option for patients considering an intervention in the near future, enhancing the competitive advantage of valve programs that offer TAVR.

Second, the international CHOICE trial favored the Sapien XT device over CoreValve for its primary composite endpoint, device implantation success. As ACC panelists emphasized, these results do not suggest that patients are always better off receiving the Sapien XT device, which is expected to receive FDA approval sometime in the near future. Trade-offs exist between Edwards’ and Medtronic’s TAVR devices, and more research is needed to define how patient characteristics impact the risks and benefits presented by the different devices.

Overall, these trials provide more evidence of TAVR’s promising future. Regardless of the device, TAVR programs across the country will need to focus on streamlining operations to work towards making the procedure profitable.

LOS management the key lever for TAVR profitability

Several speeches at ACC this year focused on optimizing TAVR operations. With approximately $30,000 per procedure device costs, TAVR’s cost effectiveness ultimately boils down to LOS management.

TAVR programs striving for the seven-day average LOS benchmark will likely continue to struggle financially. Our colleagues in the Cardiovascular Roundtable analyzed Medicare TAVR cases and found that average LOS for transfemoral cases fell from seven days to six days between the first and last quarters of 2012. 

This data demonstrates that TAVR programs are improving average LOS quickly as they gain experience with the new procedure. Panelists at ACC, however, argued that in order for TAVR to be perceived as cost-effective, average LOS for lower risk TAVR patients will need to drop to two or three days.

Our international counterparts are proving that this is possible, especially with second generation devices such as the CoreValve and the Sapien XT. One single center study of a TAVR program in Vancouver using the Sapien XT device found that “rigorous patient screening and improvements in procedural guidance and device selection permits safe next day discharge in high risk patients.” While this is an extreme example, research certainly indicates that TAVR LOS reduction is possible and, for many programs, financially necessary.

Get a head start in reducing LOS for TAVR cases with the Cardiovascular Roundtable’s “10 steps to lower TAVR length of stay from The Queen’s Medical Center,” and contact your Dedicated Advisor for customized support from Service Line Strategy Advisor.

More from ACC 2014

Want more information on innovations highlighted at ACC? Check out the other posts in our series.

ACC 2014: Renal denervation results call for further investigation
ACC 2014: Radial PCI learning curve may be overstated
ACC 2014: The future of aortic aneurysm care—PEVAR in the cath lab