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With TAVI , the recovery is much quicker and regaining normal activities is much , much quicker than after surgery these are rarely used in practice , with doctors relying on the patient ’ s self-reported reduction in symptom burden .
Has the introduction of TAVI improved hospital efficiencies ? Professor Kharbanda believes that TAVI improves hospital efficiencies . As he clarified : “ valve replacement surgery requires a cardiac surgeon and their surgical team , a prolonged hospital stay and then the rehabilitation afterwards ”. He feels that in terms of this procedure that , “ it increases those hospital efficiencies : patients are in much quicker , they don ’ t require the same level of high intensity beds , and they are discharged much quicker .” Moreover , as clinicians become more accomplished at undertaking the procedure , this too introduces efficiencies .
TAVI is also more efficient than surgery and Professor Kharbanda described how , in terms of throughput , surgeons can generally perform around two valve replacement procedures each day , compared with up to four TAVIs in a typical day . Although cost-effectiveness analyses comparing the procedure with surgery are underway , one limiting factor cited by Professor Kharbanda is the cost of the TAVI valves , which , he explained , cost much more than the few thousand pounds for a surgical valve . Nevertheless , he noted that in comparison to surgery , “ there is the cost of the intensive care , the cost of further hospital stays and the hidden costs of the prolonged recovery , which are never going to be captured by the normal models ”.
Are there any specific barriers to the adoption of TAVI ? Professor Kharbanda feels that cost and some remaining concerns over the very long-term outcomes for these valves are still a potential barrier to TAVI , adding that “ in younger patients , surgery may still be appropriate , but for most patients in their later decades , this ( TAVI ) is still a very good procedure ”.
He described how TAVI services in the UK are commissioned and regulated so that a hospital cannot simply decide to only offer TAVI as it was still necessary for a hospital to have a surgical team as back-up in case of any problems .
What were the biggest challenges in your hospital to TAVI services during the pandemic ? While many services at the hospital halted during the pandemic , fortunately , at Oxford TAVI procedures continued . Professor Kharbanda felt that his department was very fortunate and “ able to undertake the procedures at a local private hospital ” funded by central government . This enabled all COVID-19 screened negative patients to have their procedure undertaken . However , not all TAVI centres received additional funding and temporarily closed but he noted one positive effect of the pandemic was that “ some patients who were destined for surgery were also diverted to TAVI because obviously intensive care facilities were being used and surgery wasn ’ t happening ”. Currently , he says , the challenges are the very long waiting lists .
Looking forward , what do you think are the most likely innovations ? Professor Kharbanda hopes that in the future , the “ key thing is to take away the unpredictability ”, i . e ., “ getting a consistent result safely ”. As he continued , “ initially we were learning how to do TAVI , we were learning how to get the valve in to reach the heart ; now I think it ’ s the nuances of getting exactly the correct result and reducing complications ”. But complications are still a problem . As Professor Kharbanda mentioned , “ stroke remains at 2 % and we are currently doing a trial to look at devices that might reduce the risk of stroke ”. He added that pacemakers are also an issue and that one in ten patients might require a pacemaker after TAVI and suspects that as technology moves on , “ there might be temporary pacing within the devices ”. Looking into the future , he believed that it might be possible for innovations , some of which are currently unimageable , might happen such as cages that disappear over time and leave the valve . One of the biggest complications arose from bleeding and that as devices improved , perhaps being made even smaller , this offered several advantages . As he explained , “ you are inserting a large tube into an artery in the leg but as those devices become lower calibre , more deliverable , and less rigid , the procedure is likely to become safer from that perspective .” Newer devices , he said , can seal the hole created in the artery and this has further reduced the complication rate in the legs . As he noted , “ complication rates were 5 % or 6 % from the leg and these are now down to 2 % or 3 %” and getting better as we understand more about these devices .”
Finally , he believes that the future is bright and that , “ we are going to get better devices , we are going to get better at putting them in and we are going to get better at knowing which patients need which device and we are going to get better at dealing with complications .” >