Strategies for an Effective Structural Heart Program: Current and Future Considerations

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. 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 2 Cardiac Surgeons 1 Cardiologist 1 NP Patients seen at separate offices Implants one day a month • 3 Cardiac Surgeons • 4 Cardiologists • Dedicated Director • 2 NPs • 3 RNs • 2 Coordinators • Dedicated Valve Clinic (physical not virtual) • Dedicated Imaging • Cardiac Anesthesia

15. 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. 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

23. INOVA TAVR Payment & Contribution Margin/Case

24. 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. 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! eric.sarin@inova.org

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