1. Strategies for an Effective Structural Heart Program: Current and Future Considerations
Eric L. Sarin, MD
Co-Director, Structural Heart and Valve Program
Co-Director, Cardiovascular Research
Inova Heart and Vascular Institute

2. Disclaimer
Please Note: The information provided is the experience of Inova Fairfax Medical Campus, and Edwards Lifesciences has not independently evaluated these data. Outcomes are dependent upon a number of facility and surgeon factors which are outside Edwards’ control. These data should not be considered promises or guarantees by Edwards that the outcomes presented here will be achieved by an individual facility.
Eric L. Sarin is a paid consultant to Edwards Lifesciences

3. About us…

4. About us… TAVR program began in 2010 Hybrid room built
Strong administrative support
Enthusiasm about the program, but tepid enrollment and growth.

5. Inova TAVR Growth

6. Starting a program? Need to be ready
Exponential growth
Complex patients
Multiple diagnostic tests
Multiple specialists involved
New technologies/ procedures

7. Why Build a SHD infrastructure?
Optimize the overall workflow and patient experience
Pre-op screening
Procedural Outcomes
Post-op follow-up
Facilitate research trials
Most importantly, to have a solid foundation to allow for continued growth and easy transition/ adoption of new technologies

8. TAVR should lay the foundation for other programs

9. Insight from multiple physicians allows for best possible care
The Heart Team Concept
Multidisciplinary approach to patient assessment and treatment planning
Insight from multiple physicians allows for best possible care

10. Building your ‘Dream Team’
Look for motivated individuals
Interest in new technology
Fellowship in SHD
Team Players
Focus on the best treatment for the particular disease/patient, not on the procedures themselves
Aligned incentives, lack of competition
Unbiased decision making

11. Recipe for Success Administrative support Programmatic goals
Vision and strategy for growth and improvement
TAVR team
Collaboration between essential specialties
Interventional Cardiology
CT surgery
Echo
Radiology
Heart Failure
Anesthesia
Nursing

12. Necessary ingredients
Collaborators
Surgeon, Cardiologist, Radiologist, Anesthesiologist, Echocardiologist, Heart Failure specialist
Program infrastructure
At least one dedicated NP/RN/PA
Efficient evaluation
Patient triage
Assist with clinical oversight
Patient/ family education
Admin support
Phone number
database

13. Procedural requirements
Hybird OR/ Cath Lab
Institution dependent
Be prepared for anything
CPB availability
Staff education/ Training
Core group
Cross training
Repeatable environment
Worst case scenario

14. IHVI Past/ Present Infrastructure
2010
2017
3 Cardiac Surgeons
4 Cardiologists
Dedicated Director
2 NPs
3 RNs
2 Coordinators
Dedicated Valve Clinic (physical not virtual)
Dedicated Imaging
Cardiac Anesthesia
2 Cardiac Surgeons
1 Cardiologist
1 NP
Patients seen at separate offices
Implants one day a month

15. As much as possible before visit
Valve Clinic
One stop shop
Easy access
2 Surgeon visits
Interventional cardiologist eval
Echo
Registry
As much as possible before visit
As much as possible day of visit
As little as possible after visit

16. Structural Valve Clinic
Identify team members, designate roles
Formalize
Managing referrals
Evaluating patients
Operations
Standard channels of communication
Follow-up
Adapt/ Evolve
Regular Q/I meetings to address outcomes, finanicials

17. Processes Referrals Telephone triage/scheduling
Reciept and review of records
Communication
Clinical
Clinic oversight
Inpatient
Education/patient/family
Team
Regular meetings
Coordination
Operations
Patient review

18. Inova TAVR Growth

19. 2016 growth by month

20. Vision for SHD program: the road forward
Continued growth of TAVR/ Mitraclip program
Active participation and recruitment in new technology trials
Continued expansion of research infrastructure
Recognition as a national leader in the treatment of SHD

21. Maintain focus on your cornerstone programs
Planning for current and future market opportunities: Keep the foundation strong!
Maintain focus on your cornerstone programs
TAVR, Mitraclip, Watchman
Exquisite results
M&M sessions
QI projects
Financial Health

22. INOVA TAVR Case Direct Costs
$46,100 if no outliers

23. INOVA TAVR Payment & Contribution Margin/Case

24. Case presentation of ViV mitral
Planning for current and future market opportunities: Think outside the box!
Creative solutions
Mitral Disease
Heart failure
Case presentation of ViV mitral

25. Institutional benefits of SHD program

26. Ready for new technology
SHD: Current/ Future
Growth in TAVR
Mitral therapies
Ready to scale
Ready for new technology

27. What I would do differently…
Start with a small team
Surgeon, Cardiologist
Build infrastructure earlier!
Clear leadership roles and hierarchy
Motivated people
Streamline patient experience
Customer service extends to referring providers!

28. Questions?
Thank you!

29. Please see important safety information at the Speaker’s Podium
Edwards, Edwards Lifesciences, the stylized E logo, SAPIEN, SAPIEN XT and SAPIEN 3 are trademarks of Edwards Lifesciences Corporation. All other trademarks are the property of their respective owners.
PP--US-2373 v1.0