Optimising patient discharge management after transfemoral transcatheter aortic valve implantation: the multicentre European FAST-TAVI trial

Abstract

Aims: Treatment pathway optimisation in TAVI should include timely patient discharge with a minimised risk for out-of-hospital adverse events. The aim of this study was to define a standardised set of risk criteria that allows a safe and timely discharge, to validate their appropriateness prospectively in different centres and multiple European countries, and to assess post-discharge outcomes. AS aortic stenosis (C)ICU(coronary) intensive care unit FAST-TAVI Feasibility And Safety of early discharge after Transfemoral TAVI IQR interquartile range NYHA New York Heart Association PPI permanent pacemaker implantation PVL paravalvular leak RBC red blood cell SD standard deviation TAVI transcatheter aortic valve implantation TIA transient ischaemic attack

Meta-analysis of randomised trials compares mortality after transcatheter versus surgical aortic valve replacement

“…Furthermore, a significantly larger proportion of the TAVI-treated patients were discharged to their own home (95.8% vs 73.1%). Several earlydischarge protocols have been published (FAST-TAVI [20], 3M-TAVR [21]) to further facilitate short hospital stays and possibly quicker recovery [22,23]. In this regard, the PARTNER 3 data show us that 30 days after the procedure only 19.7% of the TAVI-treated patients had dyspnoea (New York Heart Association class ≥2, versus 33.3% in the SAVR group), whereas TAVI-treated patients walked 32% further during the 6-min walk test and scored 38% better on the Kansas City Cardiomyopathy Questionnaire score.…”

Bring the old boys—and girls—Back home

“…Clinical outcomes were excellent and 30‐day cardiac rehospitalization was 3.7%. Interestingly, logistical reasons were named among the principal causes for prolonged hospitalization . In the Canadian and US Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) registry, next‐day discharge home was achieved in 80.1% of the patients, and within 48 hr in 89.5%, with a 30‐day cardiac readmission rate of 5.7% .…”

“…Increased feasibility of transfemoral approach will certainly play a major role. Use of a “minimalist” approach seems helpful . Strict care‐coordination is pivotal to provide early mobilization for most of the patients and physical therapy for patients at higher risk.…”

“…2,3 In the European FAST-TAVI, 71.0% of eligible patients were actually discharged <72 hr from the procedure. 2 Clinical outcomes were excellent and 30-day cardiac rehospitalization was 3.7%. Interestingly, logistical reasons were named among the principal causes for prolonged hospitalization.…”

“…Interestingly, logistical reasons were named among the principal causes for prolonged hospitalization. 2 In the Canadian and US Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) registry, next-day discharge home was achieved in 80.1% of the patients, and within 48 hr in 89.5%, with a 30-day cardiac readmission rate of 5.7%. 3 Keys for success of both registries were a risk-stratified minimalist periprocedural approach, standardization of postprocedural care with early mobilization and reconditioning, and criteria-driven discharge home.…”