12 | HOSPITAL HEALTHCARE EUROPE | 2022

Maurizio Taramasso Hospital Healthcare Europe had the pleasure of speaking with cardiologist Maurizio Taramasso , from the HerzZentrum Hirslanden Zurich , who described the significant impact TAVI has had on his patients

About the institution At his centre in Zurich , Dr Taramasso is one of three cardiologists specifically involved in structural interventions , although there are around ten interventional cardiologists in total . Together with two other colleagues , Dr Taramasso is involved not only in TAVI but also in mitral and tricuspid interventions .

Why and when was TAVI introduced at your centre ? Although Dr Taramasso has been performing TAVI since 2008 , in his current role , the hospital only introduced the procedure once he arrived , making use of his experience and skills to enable the centre to undertake a wider range and greater number of cardiovascular interventions . He estimates that his centre will perform around 100 TAVI procedures per year , which is slightly less than at his previous hospital , which performs more than 200 TAVIs per year , making his current centre the second largest in Zurich .

What are your perceptions of how TAVI affects patient outcomes ? Dr Taramasso described TAVI as “ one of the biggest revolutions in cardiovascular medicine over the last decades and one that has had a significant impact on the lives and outcomes of patients ”. For example , at follow-up appointments he described how patients were ‘ almost literally transformed ’ and reported feeling much better .

What about the economic impact for hospitals ? Dr Taramasso explained how both clinical and economic factors influence the duration of a patient ’ s hospital stay . After the procedure , patients usually stay for a minimum of three days and , from a clinical perspective , this was advisable because an atrioventricular block can occur within 72 hours and the patients need to be monitored . A second , but equally important , factor from the hospital ’ s perspective was that the maximum reimbursement was only payable if the patient remains in hospital for between three and ten days . This was despite the fact that clinically , patients with a permanent pacemaker “ could , if the procedure goes smoothly , be potentially discharged the same day or even the day after .” By contrast , surgical patients would need to remain in hospital for “ five to seven days and then require at least two weeks of rehabilitation .”

There are clear economic advantages for hospitals from TAVI compared with surgery , due , for example , to a reduced length of stay , but disparities in cost continues to pose a problem in countries without an appropriate reimbursement for TAVI . Dr Taramasso feels that impetus to perform more TAVI procedures was driven by clinical rather than economic factors , at least in Switzerland , although accepted that from the hospital ’ s perspective , TAVI was likely to be more cost-effective unless there were complications .

Are there any particular barriers to implementing TAVI procedures ? Dr Taramasso believes the main barrier to undertaking more TAVI procedures is the absence of data on the durability of the valve .

He feels that longer-term valve durability is an important and influential factor when deciding between TAVI and surgery , more so when treating younger patients , and that more data are required . He discussed that while some clinical trial data comparing TAVI with surgical valves showed a similar durability after approximately eight years , other work demonstrated “ how after two to three years , the survival curves tend to invert , so perhaps something happened due to the creeping of the valves . But we just need more data .”

Although the final decision is make by consensus within the heart team , this might not always be clear cut . As he said , “ for an old patient with a lot of copathologies , it is easy to say TAVI ; for a young patient with no copathology , it is easy to say surgery .” However , there is always a grey zone and for which a discussion is warranted and often helpful . He explained how while a major determinant in the decision between TAVI and surgery was age , CT imaging also played an important role in guiding the decision-making . “ We know from CT that there are some really good cases for TAVI and some that are not so ; for example , if the CT imaging demonstrated a highly calcified valve with the risk of coronary occlusion or bad peripheral vessels . So I think CT impacts the final decision .”

What were the biggest challenges during the COVID-19 pandemic ? Dr Taramasso mentioned that his centre continued to perform TAVI during the pandemic simply because the procedure does not require intensive care beds . However , they were unable to treat elective patients but would do so only if they became symptomatic , were worsening rapidly , or