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University of Michigan Health – Sparrow Lansing’s vascular complication rates were higher than average for 2018 – 2019.  The structural heart team including Miriam Glardon, RN, BSN; Lindsey Montgomery, RN; Jason Inman, PAC; Jennifer Katafiasz, MSN, RN; Leisa Lamey, RN; Mohammed Qintar, MD; Nam Cho, DO; Hisham Qandeel, MD; and Kirill Zakharov, DO set out to make improvements.

The team had been doing two femoral access sites for all TAVR patients. However, they switched to utilizing the best possible alternative access when femoral access was not ideal and started doing distal radial punctures for the non-TAVR site instead of another groin puncture. They were already familiar with radial access from PCI but applying it to TAVR was a new experience.

“We believe that a clean alternative access is better than borderline femoral access,” explained Dr. Qintar. “We are one of the few sites that does distal radial access for TAVR cases.”

Additionally, the team utilized Lithotripsy when needed to allow borderline femoral cases when an alternative access is not ideal.

“Change is always hard,” said Dr. Qintar. “We had to do a lot of education for our cath lab teams and our cardiovascular specialty unit nurses and later did a few teaching sessions about the change we adopted."

The structural heart team taught best practices about large bore access; the benefits of radial access over femoral access and, more specifically, the benefits of distal radial access. They also created a “vascular rescue” kit and talked about scenarios of bail-out to improve the process.

By using distal radial puncture, along with meticulous TAVR access, U-M Health – Sparrow Lansing was able to decrease vascular complications to 0% in 2022 and 0.8% in 2023. This also resulted in a length of stay (LOS) of a mean of 1 day in 2023.

Despite an increased volume and complexity of patients, education and meticulous planning resulted in U-M Health – Sparrow Lansing achieving a 0% mortality rate over the last three years. “We are very excited about sharing our results and our experience,” said Dr. Qintar.

U-M Health – Sparrow Lansing’s commitment to patients is evident in this improvement and the team continues to strive to find ways to increase quality of care and patient outcomes and satisfaction.