Impact of early hospital discharge on clinical outcomes after transcatheter aortic valve implantation

Abstract

Aims Early discharge after transcatheter aortic valve implantation (TAVI) may potentially impact post‐procedural safety of the patient. The study aim was to compare safety of TAVI in patients planned for fast track hospital stay with patients planned for standard hospital stay. Methods and results All‐comers patients undergoing transfemoral TAVI between 2011 and 2017 were allocated to two matched groups depending whether the procedure was performed before or after transition from standard to fast track course. Data on vital status and hospitalizations were obtained through national registries. Three hundred and nineteen matched pairs were eligible for analysis. The median length of post‐procedural stay was 3 days (IQR: 2–4) for patients in the fast track group compared to 6 days (IQR: 4–8) in the standard approach group (p < .0001). There was no difference in all‐cause mortality between groups at 30‐day (1.3% vs. 1.9%, p = .52) or 90‐day follow‐up (2.9% vs. 4.1%, p = .42). There was no difference in the risk of new permanent pacemaker implantation (PPI) in pacemaker naïve patients between groups at 30‐day (15.8% vs. 21.2%, p = .16) or 90‐day follow‐up (15.8% vs. 21.9%, p = .12). There was no difference in the rate of rehospitalization between groups between discharge and 90‐day follow‐up (2.09 per patient‐year vs. 2.09 per patient‐year, p = .99). Conclusions Early discharge in an all‐comers population undergoing transfemoral TAVI is safe with regards to all‐cause mortality, need for PPI, and rehospitalization.

Proper Selection Does Make the Difference: A Propensity-Matched Analysis of Percutaneous and Surgical Cut-Down Transfemoral TAVR

“…This may affect the outcome in two ways. The slower recovery of the surgical group may predispose to prolonged immobilization and increased infections rates [15,16], which are all known concerns in these frail surgical candidates. Indeed, lymphoceles and paresthesia complications are quite more common when a surgical femoral isolation is performed [17].…”

A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence

“…These improved outcomes were also associated with reduced in-hospital stay, with the median time from procedure to discharge falling from 130 h (2013) to 64 h (2016) ( 20 ). An all-corners patients’ retrospective analysis has shown that a fast-track median length of post-TAVI in-hospital stay of 3-days compared to a standard 6-day in-hospital stay did not have any difference in all-cause mortality (1.3 vs. 1.9%), rate of rehospitalization after discharge (2.09 per patient-year vs. 2.09 per patient-year) and rate of permanent pacemaker implantation (PPI) in pacemaker naive patients at 90 days (15.8 vs. 21.9%) ( 21 ). In addition, two prospective studies the 3M-TAVR and FAST-TAVI have shown that next-day discharge is safe in judiciously selected patients who undergo uncomplicated transfemoral TAVI ( 22 , 23 ).…”

Same-day discharge after percutaneous closure of persistent foramen ovale using intracardiac echocardiography and the Gore Septal Occluder

“…Vascular closure devices (VCD) provide reliable access site control and allow for rapid mobilisation after procedures. These improvements have allowed for an increasing possibility of same-day discharge (SDD) after catheter-based interventions (13)(14)(15)(16)(17)(18)). An extensive review and summary discussing the feasibility of SDD after numerous transcatheter procedures was published by Asbeutah et al (18).…”