Same-Day Discharge Post–Transcatheter Aortic Valve Replacement During the COVID-19 Pandemic

Barker, Madeleine; Sathananthan, Janarthanan; Perdoncin, Emily; Devireddy, Chandan; Keegan, Patricia; Grubb, Kendra J.; Pop, Andrei; Depta, Jeremiah P.; Rai, Devesh; Abtahian, Farhad; Spence, Mark S.; Mailey, Jonathan; Muir, Douglas; Russo, Mark J.; Pineda‐Salazar, Jennifer; Okoh, Alexis K.; Smith, Meghan; Dahle, Thom G.; Rana, Masud; Alfadhel, Mesfer; Meier, David; Chatfield, Andrew G.; Akodad, Mariama; Chuang, Anthony; Samuel, Rohit; Nestelberger, Thomas; McAlister, Cameron; Lauck, Sandra; Webb, John G.; Wood, David

doi:10.1016/j.jcin.2021.12.046

Cited by 24 publications

(30 citation statements)

References 17 publications

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“… 25 , 33 , 34 To address the constraints placed on the health care system during the COVID‐19 pandemic, the Post‐TRanscatheter AOrtic Valve Replacement Using a STandardizEd Clinical PaThway (PROTECT TAVR) multicenter study demonstrated the safety and feasibility of SDD TAVI and suggests its potential use during times of crisis. 35 The study provided an SDD clinical pathway that excluded patients with preexisting bundle‐branch blocks. 35 Excluding patients with a preexisting bundle‐branch block is consistent with our reported findings that patients with a right bundle‐branch block or left bundle‐branch block are not ideal candidates for SDD‐TAVI.…”

Section: Discussionmentioning

confidence: 99%

Same‐Day Discharge After Transcatheter Aortic Valve Implantation: Insights from the Nationwide Readmission Database 2015 to 2019

Zahid

Rai

Din

et al. 2022

JAHA

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Background There is a paucity of data on the feasibility of same‐day discharge (SDD) following transcatheter aortic valve implantation (TAVI) at a national level. Methods and Results This study used data from the Nationwide Readmission Database from the fourth quarter of 2015 through 2019 and identified patients undergoing TAVI using the claim code 02RF3. A total of 158 591 weighted hospitalizations for TAVI were included in the analysis. Of the patients undergoing TAVI, 961 (0.6%) experienced SDD. Non‐SDDs included 65 814 (41.5%) patients who underwent TAVI who were discharged the next day, and 91 816 (57.9%) discharged on the second or third day. The 30‐day readmission rate for SDD after TAVI was similar to non‐SDD TAVI (9.8% versus 8.9%, P =0.31). The cumulative incidence of 30‐day readmissions for SDD was higher compared with next‐day discharge (log‐rank P =0.01) but comparable to second‐ or third‐day discharge (log‐rank P =0.66). At 30 days, no differences were observed in major or minor vascular complications, heart failure, or ischemic stroke for SDD compared with non‐SDD. Acute kidney injury, pacemaker implantation, and bleeding complications were lower with SDD. Predictors associated with SDD included age <85 years, male sex, and prior pacemaker placement, whereas left bundle‐branch block, right bundle‐branch block, second‐degree heart block, heart failure, prior percutaneous coronary intervention, and atrial fibrillation were negatively associated with SDD. Conclusions SDD following TAVI is associated with similar 30‐day readmission and complication rates compared with non‐SDD. Further prospective studies are needed to assess the safety and feasibility of SDD after TAVI.

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Section: Discussionmentioning

confidence: 99%

Same‐Day Discharge After Transcatheter Aortic Valve Implantation: Insights from the Nationwide Readmission Database 2015 to 2019

Zahid

Rai

Din

et al. 2022

JAHA

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“…Considering the high immediate success rate of TAVR, the minimalist strategy does not include systematic echocardiography to assess the result of the procedure in the catheterization laboratory [ 6 , 7 ]. However, an experienced echocardiographer must be available during each TAVI procedure.…”

Section: Per-procedural Echographymentioning

confidence: 99%

“…There is an increasing trend toward shorter hospital stays after TAVR procedures, in particular for patients undergoing the procedure via transfemoral access [ 1 , 6 , 7 ].…”

Section: Early Dischargementioning

confidence: 99%

“…Despite improvements in the results, TAVR remains associated with specific complications, primarily vascular complications and conductive disorders, which can increase the hospitalization length of stay [ 6 , 7 ].…”

Section: Early Dischargementioning

confidence: 99%

“…The care pathway for patients undergoing transcatheter aortic valve replacement (TAVR) was initially based on open surgery standards and often included general anesthesia (GA), per-procedural invasive monitoring, systematic transesophageal echocardiography and intensive care unit (ICU) admission. Considering improvements in procedural outcomes and the decreasing surgical risk of patients undergoing TAVR, fast-track protocols were recently developed for transfemoral TAVR in numerous centers and tend now to generalize [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. The aims of simplifying the procedure were mainly to allow rapid recovery and early ambulation and discharge and to improve patient satisfaction and to reduce hospital costs without compromising safety.…”

Section: Introductionmentioning

confidence: 99%

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Simplified TAVR Procedure: How Far Is It Possible to Go?

Leclercq

Meunier

Gandet

et al. 2022

JCM

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Increasing operators’ experience and improvement of the technique have resulted in a drastic reduction in complications following transcatheter aortic valve replacement (TAVR) in patients with lower surgical risk. In parallel, the procedure was considerably simplified, with a routine default approach including local anesthesia in the catheterization laboratory, percutaneous femoral approach, radial artery as the secondary access, prosthesis implantation without predilatation, left ventricle wire pacing and early discharge. Thus, the “simplified” TAVR adopted in most centers nowadays is a real revolution of the technique. However, simplified TAVR must be accompanied upstream by a rigorous selection of patients who can benefit from a minimalist procedure in order to guarantee its safety. The minimalist strategy must not become dogmatic and careful pre-, per- and post-procedural evaluation of patients with well-defined protocols guarantee optimal care following TAVR. This review aims to evaluate the benefits and limits of the simplified TAVR procedure in a current and future vision.

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Improving access to transcatheter aortic valve implantation across Europe by restructuring cardiovascular services: An expert council consensus statement

Zamorano

Appleby

Benamer

et al. 2023

Cathet Cardio Intervent

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Transcatheter aortic valve implantation (TAVI) is recommended for a growing range of patients with severe aortic stenosis in the European Society of Cardiology and European Association for Cardio‐Thoracic Surgery (ESC/EACTS) 2021 Guidelines update. However, guideline implementation programs are needed to ensure the application of clinical recommendations which will favorably influence disease outcomes. An Expert Council was convened to identify whether cardiology services across Europe are set up to address the growing needs of patients with severe aortic stenosis for increased access to TAVI by identifying the key challenges faced in growing TAVI programs and mapping associated solutions. Wide variation exists across Europe in terms of TAVI availability and capacity to deliver the increased demand for TAVI in different countries. The recommendations of this Expert Council focus on the short‐to‐medium‐term aspects where the most immediate, actionable impact can be achieved. The focus on improving procedural efficiency and optimizing the patient pathway via clinical practice and patient management demonstrates how to mitigate the current major issues of shortfall in catheterization laboratory, workforce, and bed capacity. Procedural efficiencies may be achieved through steps including streamlined patient assessment, the benchmarking of standards for minimalist procedures, standardized approaches around patient monitoring and conduction issues, and the implementation of nurse specialists and dedicated TAVI coordinators to manage organization, logistics, and early mobilization. Increased collaboration with wider stakeholders within institutions will support successful TAVI uptake and improve patient and economic outcomes. Further, increased education, collaboration, and partnership between cardiology centers will facilitate sharing of expertise and best clinical practice.

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Same-Day Discharge Post–Transcatheter Aortic Valve Replacement During the COVID-19 Pandemic

Cited by 24 publications

References 17 publications

Same‐Day Discharge After Transcatheter Aortic Valve Implantation: Insights from the Nationwide Readmission Database 2015 to 2019

Same‐Day Discharge After Transcatheter Aortic Valve Implantation: Insights from the Nationwide Readmission Database 2015 to 2019

Simplified TAVR Procedure: How Far Is It Possible to Go?

Improving access to transcatheter aortic valve implantation across Europe by restructuring cardiovascular services: An expert council consensus statement

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