Brigham’s TAVR Program Achieves High Volume with Speed and Efficiency

It’s estimated that approximately 168,000 TAVR procedures will be performed annually in the United States. According to Pinak Bipin Shah, MD, most TAVR programs grew quickly after the FDA decreased the risk-level indication, but many programs have plateaued.

Marc Pelletier headshot
Marc P. Pelletier, MD
Pinak Shah headshot
Pinak Bipin Shah, MD

“Most TAVR programs just don’t have the capacity to perform a large number of weekly procedures. The Brigham’s TAVR Program is unique, because we haven’t stopped growing,” said Dr. Shah, Director of the Cardiac Catheterization Lab (where most TAVRs are performed).   

In fact, Brigham’s TAVR Program has steadily grown since the procedure went into commercial practice in 2011. In April 2018, the Program celebrated it’s 1,000th case, making it the fastest to reach this milestone in New England. The Program is on pace to reach 1,300 by the end of 2018.    

Reaching this milestone was facilitated by a number of efficiencies that offer patients easy access and relatively rapid evaluation and treatment.   

TAVR Performed Without General Anesthesia

More than 90 percent of patients who undergo TAVR at the Brigham are awake and under conscious sedation. Without general anesthesia, the procedure is less invasive and takes much less time. Patients are also mobilized faster and recover quicker, especially the elderly. Most patients return home the day after surgery.      

TAVR Offered in the Catheterization Lab   

Most TAVRs are performed in the Brigham’s Cardiac Catheterization Lab, a dedicated space that offers advantages over a traditional operating room. “It’s a simpler environment compared to busy operating rooms. We can offer faster care to our patients,” said Dr. Shah. 

Multidisciplinary Collaboration  

A multidisciplinary team approach is at the core of the TAVR team’s success. “To perform this procedure, it’s not just cardiac surgeons, or interventional cardiologists. It’s anesthesiologists, nurses, non-interventional cardiologists, physician assistants, radiologists, fellows, among many others,” said Marc P. Pelletier, MD, Surgical Director of the TAVR Program. He joined the Heart & Vascular Center in 2016.    

Easy Access, Efficient Evaluation, Rapid Treatment

The comprehensive approach to TAVR enables the Program to assess referrals quickly and offers faster, smoother recoveries for patients. 

“We make it easy for patients to receive an evaluation. We also offer consultations three days a week and aim to see patients within a week after contacting us. We can typically operate within 2-to-3 weeks of their initial consultation,” said Dr. Shah.

The Brigham also has the infrastructure to perform TAVRs any day of the week, which maximizes access and has contributed to the high TAVR volume at the Brigham, while ensuring patients don’t have to wait long in the hospital for their procedure.    

All Specialists and Tests in One Day

The TAVR Program aims to provide a one-stop-shop for patients. A single visit to the hospital typically includes meetings with multiple specialists. Patients also receive most, if not all, of their imaging and testing in one day, minimizing the need to visit the hospital multiple times.  

The Future of Brigham’s TAVR Program

The Cardiac Catheterization Lab is in the process of expanding. By June of 2019, the Cath Lab will finish construction and offer five state-of-the-art rooms for cardiac procedures, including TAVR.  

“The expansion will allow us to increase our efficiencies ever further, so we can perform more TAVRs to meet increasing demand, while maintaining safety and excellent outcomes,” said Dr. Pelletier.