On Demand: Clinical and Operational Strategies to Improve Outcomes in Urgent TAVR Care-Presentation Slides

Presentation Slides

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The 2025 MedAxiom presentation focuses on clinical and operational strategies to improve outcomes in urgent Transcatheter Aortic Valve Replacement (TAVR) care. Urgent TAVR, performed on inpatients with symptomatic aortic stenosis (AS), is linked to higher mortality, complications, longer hospital stays (8 days vs. elective), and increased costs (~$16,000 more per case), while also straining procedural capacity.<br /><br />Key challenges include that 25% of TAVRs at referral centers occur in hospitalized patients, many of whom could be stabilized and safely discharged for elective procedures. Early recognition and diagnosis of AS are critical to prevent urgent cases, but under-recognition and slow referrals remain common despite frequent prior healthcare encounters. Structured referral pathways, stronger provider communication, and surveillance programs are essential.<br /><br />Case studies from Oregon Health & Sciences University (OHSU) and Memorial Healthcare in Florida demonstrate improvements through multidisciplinary teams, structured inpatient algorithms for stability evaluation, and operational strategies. OHSU improved urgent TAVR rates while maintaining excellent clinical outcomes; Memorial reduced urgent TAVRs from 19% in 2021 to 1.3% in 2024 by using escalation protocols and multidisciplinary evaluation pathways.<br /><br />Balloon Aortic Valvuloplasty (BAV) is highlighted as a valuable bridge therapy for unstable patients or those needing stabilization before valve replacement. BAV reduces mortality, length of stay, and costs compared to urgent TAVR alone, especially when followed by elective TAVR within 30 days.<br /><br />Operational strategies include coordinated heart teams, flexible cath lab scheduling, the use of TAVR coordinators for patient navigation, and system capacity management to reduce urgent cases, improve workflow, and enhance financial sustainability.<br /><br />Future directions emphasize broader adoption of echocardiographic surveillance, formal inpatient TAVR decision algorithms incorporating clinical and social factors, integration of electronic health record alerts, and continuous monitoring of patient outcomes to decrease urgent TAVR incidence.<br /><br />In summary, combining early detection, clinical stabilization with BAV, multidisciplinary collaboration, and operational discipline optimizes urgent TAVR care for better patient and system outcomes.

Keywords

Urgent TAVR

Aortic Stenosis

Balloon Aortic Valvuloplasty

Multidisciplinary Teams

Clinical Stabilization

Operational Strategies

Referral Pathways

Echocardiographic Surveillance

Patient Outcomes

Healthcare Cost Reduction