Analysis of length of stay after transfemoral transcatheter aortic valve replacement: results from the FRANCE TAVI registry

Abstract

Background: Currently, there are no recommendations regarding the minimum duration of in-hospital 4 monitoring after transfemoral (TF) transcatheter aortic valve replacement (TAVR) and practices are extremely 5 heterogeneous. We therefore aimed to evaluate length of stay (LOS) and predictive factors for late discharge 6 after TF TAVR using data from the FRANCE TAVI registry. 7Methods: TAVR was performed in 12,804 patients in French centers between and 2015. LOS was evaluated in 5,857 TF patients discharged home. LOS was calculated from TAVR procedure (day 0) to 9 discharge. The study population was divided into 3 groups based on LOS values. Patients discharged within 3 10 days constituted the "very early" discharge group, patients with a LOS between 3 and 6 days constituted the 11 "early" discharge group, and patients with a length of stay >6 days constituted the "late" discharge group.12 Results: The median LOS was 7 (5-9) days and was extremely variable among centers. The proportion of 13 patients discharged very early, early, and late was 4.4% (n=256), 33.7% (n=1997), and 61.9% (n=3624) 14 respectively. Variables associated with late discharge were female sex, co-morbidities, major complications, self 15 expandable valve, general anesthesia, and a significant center effect. In contrast, history of previous pacemaker 16 was a protective factor. The composite of death and re-admission in the very early and early versus late 17 discharge groups were similar at 30 days (3.3% vs. 3.5%, p=0.66). 18Conclusions: LOS is extremely variable after TF TAVR in France. Co-morbidities and complications were 19 predictive factors of late discharge after TAVI. Interestingly, the use of self-expandable prosthesis and general 20 anesthesia may also contribute to late discharge. Our results confirm that early discharge is safe.

Metabolomic profiling of patients with high gradient aortic stenosis undergoing transcatheter aortic valve replacement

“…Over the last decade, the use of transcatheter aortic valve replacement (TAVR) has expanded and now represents the therapy of choice in elderly patients with symptomatic severe AS not only at high or moderate but also at low surgical risk [1][2][3][4][5]. Compared to surgical aortic valve replacement (SAVR), TAVR has benefits associated with shorter hospitalization, faster recovery and fewer re-hospitalization rates in patients with severe AS at a low or intermediate surgical risk and in younger (< 70 years) people, respectively [6][7][8][9][10][11][12]. Overall, the 30-day mortality after TAVR is 8.4% and the survival at 1-and 5-year amounts to 83% and 48%, respectively [13,14].…”

Ambulatory TAVR: Early Feasibility Experience During the COVID-19 Pandemic

“…Based on the national French registry, about 15% of patients undergoing TAVR have a prior permanent pacemaker. 5 This is an important limitation for increased use of ambulatory TAVR procedures. Moreover, this ambulatory strategy could be associated with delayed complications such as vascular access bleeding emphasizing the need for careful post procedural monitoring.…”

Transcatheter aortic valve implantation 20 years later: early discharge after transfemoral minimalist procedures as a proof of effectiveness

“…Importantly, the authors excluded patients with a preexistent permanent pacemaker from the analysis. In previous studies, indeed, the presence of a permanent pacemaker before TAVI was a variable associated with a clear reduction in LoS, 14–16 while the need for a new permanent pacemaker implantation (PPMI) after TAVI was associated with delayed discharge 17 . Noteworthy is that this study population consisted of only transfemoral TAVI patients, 13 which is known for being associated with higher rates of early discharge 18 and lower costs 9 …”