Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era

Abstract

Objectives We sought to evaluate the safety, efficacy and feasibility of same‐day discharge after uncomplicated, minimalist TAVR. Background At the start of the COVID‐19 pandemic, we created a same‐day discharge (SDD) pathway after conscious sedation, transfemoral (minimalist) TAVR to help minimize risk of viral transmission and conserve hospital resources. Studies support that next‐day discharge (NDD) for carefully selected patients following minimalist TAVR is safe and feasible. There is a paucity of data regarding the safety of SDD after TAVR. Methods In‐hospital and 30 day outcomes of consecutive patients meeting pre‐specified criteria for SDD after minimalist TAVR at our institution between March and July of 2020 were reviewed. Outcomes were compared to a NDD cohort from July 2018 through July 2020 that would have met SDD criteria. Primary endpoints were mortality, delayed pacemaker placement, stroke and cardiovascular readmission at 30 days. Results Twenty nine patients were discharged via the SDD pathway after TAVR. 128 prior NDD patients were identified who met all criteria for SDD. The STS scores were similar between the two groups (SDD 2.6% ±1.5 vs. NDD 2.3% ± 1.2). There were no deaths at 30 days in either group. There was no significant difference in delayed pacemaker placement (SDD 0% vs. NDD 0.8%, p > .99) or cardiovascular readmission (SDD 0% vs. NDD 5.5%, p = .35) at 30 days. Conclusions Same day discharge following uncomplicated, minimalist TAVR in selected patients appears to be safe, achieving similar 30 day outcomes as a cohort of next day discharge patients.

Clinical outcomes of patients undergoing elective percutaneous coronary intervention with same-day discharge. Ten-year follow-up

“…Observational data show this strategy is safe in cases with a minimalist and uncomplicated approach. 15,16 Indirectly, these data reinforce the results of our analysis, since valve replacement is a more complex procedure from a technical and clinical standpoint, and even in the face of increased complexity, such a strategy proved to be safe.…”

Impact of the COVID-19 pandemic on the practice of endocrine surgery

“…Specht et al developed a pathway to perform mastectomy with immediate breast reconstruction as a same day procedure, with no resulting readmissions or emergency room visits in eligible patients( 11 ). Similarly, Perdoncin et al reported safe use of same day discharge after transcatheter aortic valve replacement( 12 ) and Abaza et al reported a 98 % same day discharge rate for robotic urologic procedures in response to the pandemic, up from 52 % pre-pandemic( 13 ). One of the unforeseen benefits of the pandemic may be an acceleration of the need to challenge established patterns of post-operative observation and inpatient admission in selected specialties.…”

Changing the model of care during the COVID-19 pandemic: Same-day discharge of patients undergoing elective invasive cardiac procedures in Hong Kong

“…Indeed, the prolonged influence of COVID-19 has led to the extension of the SDD strategy to patients undergoing even more sophisticated procedures, such as transcatheter aortic valve replacement. 13 …”