Clinical and Economic Outcomes of the Minimalist Approach for Transcatheter Aortic Valve Replacement

<b>Background</b>. To examine contemporary clinical and economic outcomes with implementation of a minimalist program (MP) for transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis. TAVR continues to evolve with the adoption of methods intended to maximize cost-savings while maintaining clinical effectiveness, patient safety and satisfaction. <b>Methods</b>. A multidisciplinary collaboration was undertaken to develop a MP for transfemoral TAVR using conscious sedation anesthesia (CS) and resource optimization. Outcomes for 107 patients treated with MP were compared to 107 univariate-matched control patients who underwent TAVR with general anesthesia (GA). <b>Results</b>. There were no differences between the two groups with respect to demographics, aortic stenosis severity, morbidities, symptoms, or frailty. Procedural success, major adverse complications and quality of life were also comparable. During the use of MP, there was no conversions to GA. In comparison to control patients, those who had TAVR with MP had shorter median hospital length-of-stay (LOS) (2.0 days [1.6, 2.7] vs. 3.0 days [2.0, 5.1]; p&lt;0.001). Implementation of MP was associated with a significant decrease in total variable costs of 17.9%, an increase in patients with a positive contribution margin (from 30% in 2015 to 65% in 2017), and cumulative cost savings of $3.6 million over two years. <b>Conclusions</b>. The implementation of a multidisciplinary minimalist TAVR program is associated with significant reductions in LOS and hospital costs, without compromising clinical outcomes or quality of life.