OBJECTIVES: Surgical aortic valve replacement (SAVR) has been the default treatment for sSAS, although transcatheter aortic valve implantation (TAVI) has emerged as an effective option since its introduction. CEI refers to the responsible adoption of new technologies that increase the ability of an organization to produce more, perform better, or operate at a higher level of efficiency. This study aims to quantify the role of TAVI as a CEI in reducing hospital length of stay (LoS) and its ability to expand treatment to more patients with sSAS.

METHODS: This retrospective cohort study used secondary care patient-level Hospital Episode Statistics (HES) data for England, to identify two patient cohorts from inpatient records: SAVR cohort and TAVI cohort, between January 2017 and December 2022. Each admission was associated with the Healthcare Resource Groups (HRGs) to enable the differentiation between levels of care complexity (CC). The primary outcomes, average LoS in Intensive Care Unit (ICU), post-operation (post-op) period and for the entire admission were compared between the two cohorts.

RESULTS: The HES database included 14165 TAVI and 11770 SAVR procedures across the 6 years study period. Compared to 2019, TAVI admissions increased by 26.3% in 2022 while SAVR admissions decreased by 30.3%. In 2022 the average admission LoS ranged between 4 and 10 days for TAVI and 9 and up to18 days for SAVR cases respectively for low and high CC groups. The average post op LoS ranged between 2 and 5 days for TAVI cases whilst 7 and up to 12 days for SAVR. ICU LoS was between 2 days for TAVI and 3 days for SAVR in low CC.

CONCLUSIONS: TAVI represents a CEI for sSAS patients and given that clinical practice guidelines now suggest the inclusion of lower risk patients, we expect TAVI’s contribution to the healthcare system organization to grow.