The 3M TAVR study tested one approach, the Vancouver 3M (multidisciplinary, multimodality, but minimalist) pathway, in 13 centers across Canada and the United States.
Three-hundred-fifty-one patients from the 3M TAVR study were matched to an equal number of patients who had transfemoral TAVI as part of the S3i registry embedded in the PARTNER 2A trial. The average patient age was 82, and the mean STS score (5.2 to 5.3) was in the intermediate range after matching.
There were no differences in clinical outcomes between 3M and S3i patients in the hospital, including death (0.9% vs 0.3%), MI (0 vs 0.3%), stroke (0.6 percent vs 2.0%), and repeat valve procedures (0.6% vs 0; P = NS for all). The likelihood of a 3M patient to be discharged home was more (96.3% vs. 88.9%), and they were less likely to be discharged to a rehabilitation/skilled nursing/extended care facility.
Clinical outcomes did not differ between discharge and 30 days. Shorter procedural time (total room time 115 vs 180 min; P < 0.001), and shorter hospital stays (1.6 vs 3.9 days; P < 0.001) was found in the 3M group. Along with some savings in physician costs, the 3M group had a significantly lower overall hospitalization cost ($45,595 vs. $56,438; P < 0.001).
No statistically significant difference was found in the money spent between discharge and 30 days among patients from both the groups ($3,830 vs. $4,291; P = 0.358). However, fewer days in rehab or skilled nursing facilities were spent by those in the 3M group (0.4 vs. 1.4 days per patient; P < 0.0001).
Compared to SAVR, TAVI saved approximately $9,000, according to a prior analysis of the S3i registry. When the additional savings of $11,000 observed in the current study are factored in, TAVI using a minimalist approach saves about $20,000 in treatment costs for an intermediate-risk patient when compared to surgery.