{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T23:27:37Z","timestamp":1789774057145,"version":"4.0.1"},"reference-count":18,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2023,7,27]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Severe aortic stenosis is a major cause of morbidity and mortality. The existing treatment pathway for transcatheter aortic valve implantation (TAVI) traditionally relies on tertiary Heart Valve Centre workup. However, this has been associated with delays to treatment, in breach of British Cardiovascular Intervention Society targets. A novel pathway with emphasis on comprehensive patient workup at a local centre, alongside close collaboration with a Heart Valve Centre, may help reduce the time to TAVI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The centre performing local workup implemented a novel TAVI referral pathway. Data were collected retrospectively for all outpatients referred for consideration of TAVI to a Heart Valve Centre from November 2020 to November 2021. The main outcome of time to TAVI was calculated as the time from Heart Valve Centre referral to TAVI, or alternative intervention, expressed in days. For the centre performing local workup, referral was defined as the date of multidisciplinary team discussion. For this centre, a total pathway time from echocardiographic diagnosis to TAVI was also evaluated. A secondary outcome of the proportion of referrals proceeding to TAVI at the Heart Valve Centre was analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean\u00b1SD time from referral to TAVI was significantly lower at the centre performing local workup, when compared with centres with traditional referral pathways (32.4\u00b164\u2009to 126\u00b1257 days, p&lt;0.00001). The total pathway time from echocardiographic diagnosis to TAVI for the centre performing local workup was 89.9\u00b167.6\u2009days, which was also significantly shorter than referral to TAVI time from all other centres (p&lt;0.003). Centres without local workup had a significantly lower percentage of patients accepted for TAVI (49.5% vs 97.8%, p&lt;0.00001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>A novel TAVI pathway with emphasis on local workup within a non-surgical centre significantly reduced both the time to TAVI and rejection rates from a Heart Valve Centre. If adopted across the other centres, this approach may help improve access to TAVI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2022-002170","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T12:26:01Z","timestamp":1693830361000},"page":"e002170","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Time to TAVI: streamlining the pathway to treatment"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3361-0713","authenticated-orcid":false,"given":"Lynsey Jane","family":"Hewitson","sequence":"first","affiliation":[{"name":"Great Western Hospitals NHS Foundation Trust, Swindon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzane","family":"Cadiz","sequence":"additional","affiliation":[{"name":"Royal Brompton & Harefield NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameeha","family":"Al-Sayed","sequence":"additional","affiliation":[{"name":"Royal Brompton & Harefield NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Fellows","sequence":"additional","affiliation":[{"name":"Great Western Hospitals NHS Foundation Trust, Swindon, UK"},{"name":"Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaaeldin","family":"Amin","sequence":"additional","affiliation":[{"name":"Great Western Hospitals NHS Foundation Trust, Swindon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Asimakopoulos","sequence":"additional","affiliation":[{"name":"Royal Brompton & Harefield NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Barnes","sequence":"additional","affiliation":[{"name":"Great Western Hospitals NHS Foundation Trust, Swindon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Beale","sequence":"additional","affiliation":[{"name":"Great Western Hospitals NHS Foundation Trust, Swindon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3706-648X","authenticated-orcid":false,"given":"Suzy","family":"Browne","sequence":"additional","affiliation":[{"name":"Royal Brompton & Harefield NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Badrinathan","family":"Chandrasekaran","sequence":"additional","affiliation":[{"name":"Great Western Hospitals NHS Foundation Trust, Swindon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miles","family":"Dalby","sequence":"additional","affiliation":[{"name":"Royal Brompton & Harefield NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4856-832X","authenticated-orcid":false,"given":"Paul","family":"Foley","sequence":"additional","affiliation":[{"name":"Great Western Hospitals NHS Foundation Trust, Swindon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Great Western Hospitals NHS Foundation Trust, Swindon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Haynes","sequence":"additional","affiliation":[{"name":"Great Western Hospitals NHS Foundation Trust, Swindon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ee Ling","family":"Heng","sequence":"additional","affiliation":[{"name":"Royal Brompton & Harefield NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Hyde","sequence":"additional","affiliation":[{"name":"Great Western Hospitals NHS Foundation Trust, Swindon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tito","family":"Kabir","sequence":"additional","affiliation":[{"name":"Royal Brompton & Harefield NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Khavandi","sequence":"additional","affiliation":[{"name":"Royal United Hospitals Bath NHS Foundation Trust, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Mirsadraee","sequence":"additional","affiliation":[{"name":"Royal Brompton & Harefield NHS Foundation Trust, London, 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Service specification for transcatheter aortic valve implantation. 2019. Available: https:\/\/www.bcis.org.uk\/resources\/bcis-guidance-documents\/service-specification-for-transcatheter-aortic-valve-implantation-tavi [Accessed 07 Jul 2022]."},{"key":"2025081710371658000_10.2.e002170.6","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw229"},{"key":"2025081710371658000_10.2.e002170.7","unstructured":"Cancer research UK . Cancer survival Statistics. 2021. Available: https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/survival [Accessed 28 Jul 2022]."},{"key":"2025081710371658000_10.2.e002170.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1008232"},{"key":"2025081710371658000_10.2.e002170.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814052"},{"key":"2025081710371658000_10.2.e002170.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12872-017-0668-1","article-title":"Efficacy and safety of transcatheter aortic valve replacement in aortic stenosis at low to moderate surgical risk: a comprehensive meta-analysis","volume":"17","author":"Elmaraezy","year":"2017","journal-title":"BMC Cardiovasc Disord"},{"key":"2025081710371658000_10.2.e002170.11","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000923"},{"key":"2025081710371658000_10.2.e002170.12","unstructured":"Toff WD . The United Kingdom Transcatheter valve implantation (UK TAVI) trial. Proceedings of the American College of Cardiology Virtual Annual Scientific Session Together with World Congress of Cardiology (ACC 2020\/WCC); 2020"},{"key":"2025081710371658000_10.2.e002170.13","unstructured":"Valve for Life UK . UK valve data. 2020. Available: https:\/\/www.valveforlife.co.uk\/uk-valve-data [Accessed 07 Jul 2022]."},{"key":"2025081710371658000_10.2.e002170.14","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1093\/eurheartj\/ehy244","article-title":"Transcatheter aortic valve implantation: current status and future perspectives","volume":"39","author":"Cahill","year":"2018","journal-title":"Eur Heart J"},{"key":"2025081710371658000_10.2.e002170.15","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1016\/j.athoracsur.2014.06.040","article-title":"Mortality while waiting for aortic valve replacement","volume":"98","author":"Malaisrie","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2025081710371658000_10.2.e002170.16","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2019-001233","article-title":"CT imaging prior to transcatheter aortic valve implantation in the UK","volume":"7","author":"Harries","year":"2020","journal-title":"Open Heart"},{"key":"2025081710371658000_10.2.e002170.17","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.carrev.2021.12.009","article-title":"Can transcatheter aortic valve implantation (TAVI) be performed at institutions without on-site cardiac surgery departments?","volume":"41","author":"Kobo","year":"2022","journal-title":"Cardiovascular Revascularization Medicine"},{"key":"2025081710371658000_10.2.e002170.18","first-page":"896","article-title":"Transfemoral TAVR at hospitals without on-site cardiac surgery department in Spain: a multicenter registry","volume":"12","author":"Roa Garrido","year":"2019","journal-title":"JACC: Cardiovascular Interventions"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2022-002170","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T17:37:25Z","timestamp":1755452245000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2022-002170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":18,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,9,4]]},"published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1136\/openhrt-2022-002170"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2022-002170","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9]]}}}