{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:04:17Z","timestamp":1791389057399,"version":"4.3.3"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100006520","name":"Edwards Lifesciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006520","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Universit\u00e4tsklinikum Schleswig-Holstein - Campus Kiel"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Benchmark best practices have been shown to streamline the clinical pathway for patients undergoing transcatheter aortic valve implantation (TAVI), but the impact in diverse health systems is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We evaluated the impact of Benchmark best practices implementation in Germany, Austria, France, Spain, and Italy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>International, multicentre registry of severe symptomatic aortic stenosis (AS) patients undergoing TAVI with a balloon-expandable valve, before and after Benchmark best practices implementation. Objectives were to reduce overall and intensive care unit (ICU) length of stay (LoS), and to document 30-day safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 890 patients were analysed in France, 454 in Spain, 362 in Germany, 300 in Italy, and 176 in Austria. Patients had the highest surgical risk in Germany (EuroSCORE II 6.8\u2009\u00b1\u20097.3%) and lowest in Spain (3.8\u2009\u00b1\u20092.6%). Austrian patients reported higher rates of prior myocardial infarction, severe pulmonary hypertension, and aortic valve-related symptoms at baseline. After the implementation of Benchmark best practices, the median hospital LoS was significantly reduced in France (5 vs. 3 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), Spain (6 vs. 4,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), Germany (9 vs. 6,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and Italy (7 vs. 5,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001); reductions in median ICU LoS were reported in France (1.1 vs. 0 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), Spain (1.9 vs. 1,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and Germany (1 vs. 0.9,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). Across all countries, 30-day safety outcomes were uncompromised and reduced rates of major vascular complications rates were observed in Germany (5.9 vs. 0.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The implementation of Benchmark best practices in diverse European healthcare systems resulted in reduced hospital and ICU LoS without compromising patient safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT04579445, September 28th, 2020<\/jats:p>\n                  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SL received consulting fees and support for attending meetings from Edwards Lifesciences and Medtronic. ED received consulting fees from Edwards Lifesciences. DFM received support for the present manuscript, consulting fees, payment for lectures\/presentations, and support for attending meetings from Edwards Lifesciences. DF received consulting fees from Edwards Lifesciences. CAUC received consulting fees from Edwards Lifesciences, payment for lectures\/presentations from Medtronic and Biotronik, and is on the Data Safety Monitoring Board\/Advisory Board of Medtronik. CSE received consulting fees from Medtronic, Edwards Lifesciences, and Abbott. VA received consulting fees from Boston Scientific and payment for lectures\/presentations from Edwards Lifesciences, Medtronic, and Abbott. LA received speaker feeds from Edwards Lifesciences. JM received grants, consulting fees, and payment\/honoraria for lectures\/presentations from Edwards Lifesciences, payment for lectures\/presentations from St. Jude Medical Coordination Center BVBA (Abbott), and stock on Leviticus Cardio Ltd. AS received grant from Edwards Lifesciences. LNF received consulting fees from Edwards Lifesciences and Abbott Vascular. NW received grant from Shockwave Medical and Abiomed, support for attending meetings from Edwards Lifesciences, Medtronic, and Boston, and is on the Data Safety Monitoring Board\/Advisory Board of the Cingular Study. JM (Julia Mascherbauer) received grants and support for attending meetings from Boston Scientific, Medtronic, Edwards Lifesciences, grant from Abbott, payment for lectures\/presentations from Edwards Lifesciences and AOP, is on Data Safety Monitoring Board\/Advisory Board of Amgen, and is ESC Nominating Committee Member 2022\u20132024. GMC received honoraria for consultancy for the present manuscript, educational grant, consulting fees, and payment for lectures\/presentations from Edwards Lifesciences and is now an employee of Edwards Lifesciences. JK, WW, and RR are employees of Edwards Lifesciences. PB is representing the sponsor IPPMed who received funding from Edwards Lifesciences for performing the study. VH and CL are employees of IPPMed. DF received support for the present manuscript, payment for lectures\/presentations, and support for attending meetings from Edwards Lifesciences. All other authors represent centres who received compensation from Edwards Lifesciences for the documentation of patients.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The registry was approved by the independent ethics review boards at each participating site and all patients provided written informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and informed consent"}}]}}