Gry Dahle has investigated the cost of transcatheter aortic valve implantation (TAVI), hazards for personnel in the operation room, and effects on heart function and complications.


MAIN RESULTS:

  1. Preoperative test of myocardial contractile reserve could improve selection of low-risk patients suitable for TAVI.
  2. Clinical parameters could better predict short-term outcome following TAVI than echocardiographic measurements.
  3. Surgeons and cardiologists should be aware of potentially hazardous radiation doses during TAVI.

THESIS DEFENCE:

Thesis: The Introduction of Transcatheter Aortic Valve Implantation (TAVI) – Clinical, patient experience, economical and occupational hazard issues.
Candidate: Gry Dahle
Time: June 24, 2020 at 12:15
Place: Online-based solution, due to the covid-19 situation
Link to university website


SUMMARY:

(1) Among the 50 first patients receiving TAVI at Oslo University Hospital between 2009 and 2011, seven died within the next 30 days. The mean cost exceeded 50,000 US$ per patient, exceeding the the DRG reimbursement. The cost of the device contributed to over 50% of the total costs.

(2) Just a little more than half of 64 included patients responded with better cardiac function immediately following TAVI. Among the non-responders, tho thirds died or experienced at least one cardiac event over the next year, whereas only one fourth of the responders did. In total, 17% of the patients died during the follow-up period, and the risk was three times higher among non-responders than among responders.

(4) Elevated systolic pulmonary artery pressure was the only echocardiographic parameter predicting 30-day mortality following TAVI. Clinical parameters such as heart failure, peripheral artery disease and low BMI were also independent predictors of mortality. The study includes 227 patients treated at Oslo University Hospital and University Hospital of North Norway between 2010 and 2013. 8.7% of the patients died within 30 days of the procedure.

(3) Surgeons and cardiologists should wear protective eyewear to avoid excessive radiation doses during TAVI procedures. Surgeons should also not perform too many TAVI procedures with transaortal access, as this method provides increased radiation to the body. The study used electronic dosemeters to collect dosimetric readings during 31 TAVI procedures.


REFERENCES:

(1) Dahle, G., Rein, K. A., Fiane, A., Fosse, E., Khushi, I., Hagen, T., & Mishra, V. (2012). Innovative technology-transcatheter aortic valve implantation: cost and reimbursement issuesScandinavian Cardiovascular Journal46(6), 345-352.

(2) Eidet, J., Dahle, G., Bugge, J. F., Bendz, B., Rein, K. A., Aaberge, L., … & Halvorsen, P. S. (2016). Long-term outcomes after transcatheter aortic valve implantation: the impact of intraoperative tissue Doppler echocardiographyInteractive cardiovascular and thoracic surgery23(3), 403-409.

(3) Aarsnes, A., Dahle, G., Fosse, E., Rein, K. A., Aaberge, L., & Martinsen, A. C. T. (2018). Evaluation of occupational radiation dose in transcatheter aortic valve implantation. Radiation protection dosimetry179(1), 9-17.

(4) Kjønås, D., Dahle, G., Schirmer, H., Malm, S., Eidet, J., Aaberge, L., … & Rösner, A. (2019). Predictors of early mortality after transcatheter aortic valve implantationOpen heart6(1), e000936.

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