The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study

David A. Wood, Sandra B. Lauck, John A. Cairns, Karin H. Humphries, Richard Cook, Robert Welsh, Jonathon Leipsic, Philippe Genereux, Robert Moss, John Jue, Philipp Blanke, Anson Cheung, Jian Ye, Danny Dvir, Hamed Umedaly, Rael Klein, Kevin Rondi, Rohan Poulter, Dion Stub, Marco BarbantiPeter Fahmy, Nay Htun, Dale Murdoch, Roshan Prakash, Madeleine Barker, Kevin Nickel, Jay Thakkar, Janarthanan Sathananthan, Ben Tyrell, Faisal Al-Qoofi, James L. Velianou, Madhu K. Natarajan, Harindra C. Wijeysundera, Sam Radhakrishnan, Eric Horlick, Mark Osten, Christopher Buller, Mark Peterson, Anita Asgar, Donald Palisaitis, Jean Bernard Masson, Susheel Kodali, Tamin Nazif, Vinod Thourani, Vasilis C. Babaliaros, David J. Cohen, Julie E. Park, Martin B. Leon, John G. Webb

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway. Background: Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, hospital stays average at least 6 days in most trials. The Vancouver 3M Clinical Pathway is focused on next-day discharge, made possible by the use of objective screening criteria as well as streamlined peri- and post-procedural management guidelines. Methods: Patients were enrolled from 6 low-volume (<100 TAVR/year), 4 medium-volume, and 3 high-volume (>200 TAVR/year) centers in Canada and the United States. The primary outcomes were a composite of all-cause death or stroke by 30 days and the proportion of patients successfully discharged home the day following TAVR. Results: Of 1,400 screened patients, 411 were enrolled at 13 centers and received a SAPIEN XT (58.2%) or SAPIEN 3 (41.8%) valve (Edwards Lifesciences, Irvine, California). In centers enrolling exclusively in the study, 55% of screened patients were enrolled. The median age was 84 years (interquartile range: 78 to 87 years) with a median STS score of 4.9% (interquartile range: 3.3% to 6.8%). Next-day discharge home was achieved in 80.1% of patients, and within 48 h in 89.5%. The composite of all-cause mortality or stroke by 30 days occurred in 2.9% (95% confidence interval: 1.7% to 5.1%), with neither component of the primary outcome affected by hospital TAVR volume (p = 0.51). Secondary outcomes at 30 days included major vascular complication 2.4% (n = 10), readmission 9.2% (n = 36), cardiac readmission 5.7% (n = 22), new permanent pacemaker 5.7% (n = 23), and >mild paravalvular regurgitation 3.8% (n = 15). Conclusions: Adherence to the Vancouver 3M Clinical Pathway at low-, medium-, and high-volume TAVR centers allows next-day discharge home with excellent safety and efficacy outcomes.

Original languageEnglish (US)
Pages (from-to)459-469
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume12
Issue number5
DOIs
StatePublished - Mar 11 2019
Externally publishedYes

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Critical Pathways
Stroke
Safety
Canada
Blood Vessels
Transcatheter Aortic Valve Replacement
Cause of Death
Length of Stay
Guidelines
Confidence Intervals
Mortality

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Wood, David A. ; Lauck, Sandra B. ; Cairns, John A. ; Humphries, Karin H. ; Cook, Richard ; Welsh, Robert ; Leipsic, Jonathon ; Genereux, Philippe ; Moss, Robert ; Jue, John ; Blanke, Philipp ; Cheung, Anson ; Ye, Jian ; Dvir, Danny ; Umedaly, Hamed ; Klein, Rael ; Rondi, Kevin ; Poulter, Rohan ; Stub, Dion ; Barbanti, Marco ; Fahmy, Peter ; Htun, Nay ; Murdoch, Dale ; Prakash, Roshan ; Barker, Madeleine ; Nickel, Kevin ; Thakkar, Jay ; Sathananthan, Janarthanan ; Tyrell, Ben ; Al-Qoofi, Faisal ; Velianou, James L. ; Natarajan, Madhu K. ; Wijeysundera, Harindra C. ; Radhakrishnan, Sam ; Horlick, Eric ; Osten, Mark ; Buller, Christopher ; Peterson, Mark ; Asgar, Anita ; Palisaitis, Donald ; Masson, Jean Bernard ; Kodali, Susheel ; Nazif, Tamin ; Thourani, Vinod ; Babaliaros, Vasilis C. ; Cohen, David J. ; Park, Julie E. ; Leon, Martin B. ; Webb, John G. / The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers : The 3M TAVR Study. In: JACC: Cardiovascular Interventions. 2019 ; Vol. 12, No. 5. pp. 459-469.
@article{c9d11e5549374423b0ef49033013ce24,
title = "The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study",
abstract = "Objectives: The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway. Background: Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, hospital stays average at least 6 days in most trials. The Vancouver 3M Clinical Pathway is focused on next-day discharge, made possible by the use of objective screening criteria as well as streamlined peri- and post-procedural management guidelines. Methods: Patients were enrolled from 6 low-volume (<100 TAVR/year), 4 medium-volume, and 3 high-volume (>200 TAVR/year) centers in Canada and the United States. The primary outcomes were a composite of all-cause death or stroke by 30 days and the proportion of patients successfully discharged home the day following TAVR. Results: Of 1,400 screened patients, 411 were enrolled at 13 centers and received a SAPIEN XT (58.2{\%}) or SAPIEN 3 (41.8{\%}) valve (Edwards Lifesciences, Irvine, California). In centers enrolling exclusively in the study, 55{\%} of screened patients were enrolled. The median age was 84 years (interquartile range: 78 to 87 years) with a median STS score of 4.9{\%} (interquartile range: 3.3{\%} to 6.8{\%}). Next-day discharge home was achieved in 80.1{\%} of patients, and within 48 h in 89.5{\%}. The composite of all-cause mortality or stroke by 30 days occurred in 2.9{\%} (95{\%} confidence interval: 1.7{\%} to 5.1{\%}), with neither component of the primary outcome affected by hospital TAVR volume (p = 0.51). Secondary outcomes at 30 days included major vascular complication 2.4{\%} (n = 10), readmission 9.2{\%} (n = 36), cardiac readmission 5.7{\%} (n = 22), new permanent pacemaker 5.7{\%} (n = 23), and >mild paravalvular regurgitation 3.8{\%} (n = 15). Conclusions: Adherence to the Vancouver 3M Clinical Pathway at low-, medium-, and high-volume TAVR centers allows next-day discharge home with excellent safety and efficacy outcomes.",
author = "Wood, {David A.} and Lauck, {Sandra B.} and Cairns, {John A.} and Humphries, {Karin H.} and Richard Cook and Robert Welsh and Jonathon Leipsic and Philippe Genereux and Robert Moss and John Jue and Philipp Blanke and Anson Cheung and Jian Ye and Danny Dvir and Hamed Umedaly and Rael Klein and Kevin Rondi and Rohan Poulter and Dion Stub and Marco Barbanti and Peter Fahmy and Nay Htun and Dale Murdoch and Roshan Prakash and Madeleine Barker and Kevin Nickel and Jay Thakkar and Janarthanan Sathananthan and Ben Tyrell and Faisal Al-Qoofi and Velianou, {James L.} and Natarajan, {Madhu K.} and Wijeysundera, {Harindra C.} and Sam Radhakrishnan and Eric Horlick and Mark Osten and Christopher Buller and Mark Peterson and Anita Asgar and Donald Palisaitis and Masson, {Jean Bernard} and Susheel Kodali and Tamin Nazif and Vinod Thourani and Babaliaros, {Vasilis C.} and Cohen, {David J.} and Park, {Julie E.} and Leon, {Martin B.} and Webb, {John G.}",
year = "2019",
month = "3",
day = "11",
doi = "10.1016/j.jcin.2018.12.020",
language = "English (US)",
volume = "12",
pages = "459--469",
journal = "JACC: Cardiovascular Interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",
number = "5",

}

Wood, DA, Lauck, SB, Cairns, JA, Humphries, KH, Cook, R, Welsh, R, Leipsic, J, Genereux, P, Moss, R, Jue, J, Blanke, P, Cheung, A, Ye, J, Dvir, D, Umedaly, H, Klein, R, Rondi, K, Poulter, R, Stub, D, Barbanti, M, Fahmy, P, Htun, N, Murdoch, D, Prakash, R, Barker, M, Nickel, K, Thakkar, J, Sathananthan, J, Tyrell, B, Al-Qoofi, F, Velianou, JL, Natarajan, MK, Wijeysundera, HC, Radhakrishnan, S, Horlick, E, Osten, M, Buller, C, Peterson, M, Asgar, A, Palisaitis, D, Masson, JB, Kodali, S, Nazif, T, Thourani, V, Babaliaros, VC, Cohen, DJ, Park, JE, Leon, MB & Webb, JG 2019, 'The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study', JACC: Cardiovascular Interventions, vol. 12, no. 5, pp. 459-469. https://doi.org/10.1016/j.jcin.2018.12.020

The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers : The 3M TAVR Study. / Wood, David A.; Lauck, Sandra B.; Cairns, John A.; Humphries, Karin H.; Cook, Richard; Welsh, Robert; Leipsic, Jonathon; Genereux, Philippe; Moss, Robert; Jue, John; Blanke, Philipp; Cheung, Anson; Ye, Jian; Dvir, Danny; Umedaly, Hamed; Klein, Rael; Rondi, Kevin; Poulter, Rohan; Stub, Dion; Barbanti, Marco; Fahmy, Peter; Htun, Nay; Murdoch, Dale; Prakash, Roshan; Barker, Madeleine; Nickel, Kevin; Thakkar, Jay; Sathananthan, Janarthanan; Tyrell, Ben; Al-Qoofi, Faisal; Velianou, James L.; Natarajan, Madhu K.; Wijeysundera, Harindra C.; Radhakrishnan, Sam; Horlick, Eric; Osten, Mark; Buller, Christopher; Peterson, Mark; Asgar, Anita; Palisaitis, Donald; Masson, Jean Bernard; Kodali, Susheel; Nazif, Tamin; Thourani, Vinod; Babaliaros, Vasilis C.; Cohen, David J.; Park, Julie E.; Leon, Martin B.; Webb, John G.

In: JACC: Cardiovascular Interventions, Vol. 12, No. 5, 11.03.2019, p. 459-469.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers

T2 - The 3M TAVR Study

AU - Wood, David A.

AU - Lauck, Sandra B.

AU - Cairns, John A.

AU - Humphries, Karin H.

AU - Cook, Richard

AU - Welsh, Robert

AU - Leipsic, Jonathon

AU - Genereux, Philippe

AU - Moss, Robert

AU - Jue, John

AU - Blanke, Philipp

AU - Cheung, Anson

AU - Ye, Jian

AU - Dvir, Danny

AU - Umedaly, Hamed

AU - Klein, Rael

AU - Rondi, Kevin

AU - Poulter, Rohan

AU - Stub, Dion

AU - Barbanti, Marco

AU - Fahmy, Peter

AU - Htun, Nay

AU - Murdoch, Dale

AU - Prakash, Roshan

AU - Barker, Madeleine

AU - Nickel, Kevin

AU - Thakkar, Jay

AU - Sathananthan, Janarthanan

AU - Tyrell, Ben

AU - Al-Qoofi, Faisal

AU - Velianou, James L.

AU - Natarajan, Madhu K.

AU - Wijeysundera, Harindra C.

AU - Radhakrishnan, Sam

AU - Horlick, Eric

AU - Osten, Mark

AU - Buller, Christopher

AU - Peterson, Mark

AU - Asgar, Anita

AU - Palisaitis, Donald

AU - Masson, Jean Bernard

AU - Kodali, Susheel

AU - Nazif, Tamin

AU - Thourani, Vinod

AU - Babaliaros, Vasilis C.

AU - Cohen, David J.

AU - Park, Julie E.

AU - Leon, Martin B.

AU - Webb, John G.

PY - 2019/3/11

Y1 - 2019/3/11

N2 - Objectives: The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway. Background: Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, hospital stays average at least 6 days in most trials. The Vancouver 3M Clinical Pathway is focused on next-day discharge, made possible by the use of objective screening criteria as well as streamlined peri- and post-procedural management guidelines. Methods: Patients were enrolled from 6 low-volume (<100 TAVR/year), 4 medium-volume, and 3 high-volume (>200 TAVR/year) centers in Canada and the United States. The primary outcomes were a composite of all-cause death or stroke by 30 days and the proportion of patients successfully discharged home the day following TAVR. Results: Of 1,400 screened patients, 411 were enrolled at 13 centers and received a SAPIEN XT (58.2%) or SAPIEN 3 (41.8%) valve (Edwards Lifesciences, Irvine, California). In centers enrolling exclusively in the study, 55% of screened patients were enrolled. The median age was 84 years (interquartile range: 78 to 87 years) with a median STS score of 4.9% (interquartile range: 3.3% to 6.8%). Next-day discharge home was achieved in 80.1% of patients, and within 48 h in 89.5%. The composite of all-cause mortality or stroke by 30 days occurred in 2.9% (95% confidence interval: 1.7% to 5.1%), with neither component of the primary outcome affected by hospital TAVR volume (p = 0.51). Secondary outcomes at 30 days included major vascular complication 2.4% (n = 10), readmission 9.2% (n = 36), cardiac readmission 5.7% (n = 22), new permanent pacemaker 5.7% (n = 23), and >mild paravalvular regurgitation 3.8% (n = 15). Conclusions: Adherence to the Vancouver 3M Clinical Pathway at low-, medium-, and high-volume TAVR centers allows next-day discharge home with excellent safety and efficacy outcomes.

AB - Objectives: The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway. Background: Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, hospital stays average at least 6 days in most trials. The Vancouver 3M Clinical Pathway is focused on next-day discharge, made possible by the use of objective screening criteria as well as streamlined peri- and post-procedural management guidelines. Methods: Patients were enrolled from 6 low-volume (<100 TAVR/year), 4 medium-volume, and 3 high-volume (>200 TAVR/year) centers in Canada and the United States. The primary outcomes were a composite of all-cause death or stroke by 30 days and the proportion of patients successfully discharged home the day following TAVR. Results: Of 1,400 screened patients, 411 were enrolled at 13 centers and received a SAPIEN XT (58.2%) or SAPIEN 3 (41.8%) valve (Edwards Lifesciences, Irvine, California). In centers enrolling exclusively in the study, 55% of screened patients were enrolled. The median age was 84 years (interquartile range: 78 to 87 years) with a median STS score of 4.9% (interquartile range: 3.3% to 6.8%). Next-day discharge home was achieved in 80.1% of patients, and within 48 h in 89.5%. The composite of all-cause mortality or stroke by 30 days occurred in 2.9% (95% confidence interval: 1.7% to 5.1%), with neither component of the primary outcome affected by hospital TAVR volume (p = 0.51). Secondary outcomes at 30 days included major vascular complication 2.4% (n = 10), readmission 9.2% (n = 36), cardiac readmission 5.7% (n = 22), new permanent pacemaker 5.7% (n = 23), and >mild paravalvular regurgitation 3.8% (n = 15). Conclusions: Adherence to the Vancouver 3M Clinical Pathway at low-, medium-, and high-volume TAVR centers allows next-day discharge home with excellent safety and efficacy outcomes.

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