Transcatheter aortic valve replacement same-day discharge for selected patients: a case series

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in drastic changes to the practice of medicine, requiring healthcare systems to find solutions to reduce the risk of infection. Using a case series, we propose a protocol for same-day discharge (SDD) for selected patients undergoing transcatheter aortic valve replacement (TAVR) using real-time remote cardiac monitoring. Six patients with severe symptomatic aortic stenosis underwent TAVR and were discharged on the same day. Case summary Six patients with symptomatic severe native or bioprosthetic aortic valve stenosis underwent a successful transfemoral TAVR using standard procedures, including the use of rapid atrial pacing to assess the need for permanent pacemaker implantation. Following TAVR, patients were monitored on telemetry in the recovery area for 3 h, ambulated to assess vascular access stability, and discharged with real-time remote cardiac monitoring if no new conduction abnormality was observed. The patients were seen by tele-visits within 2 days and 2 weeks after discharge. Discussion Amidst the COVID-19 pandemic, SDD following successful transfemoral TAVR may be feasible for selected patients and reduce potential COVID-19 exposure.

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

“…Prior single-center case series have demonstrated the feasibility of SDD post-TAVR in highly selected patients, with a low rate of complications postdischarge. 10 , 11 , 12 , 13 In contrast, this multicenter study spanned 3 countries: Canada, the United States, and the United Kingdom. Patient selection was left at the discretion of each multidisciplinary heart team.…”

“…Small single-center case series during the COVID-19 pandemic have demonstrated that SDD post-TAVR is feasible in highly selected patients; however, the data remain limited. 10 , 11 , 12 , 13 …”

Same day discharge after structural heart disease interventions in the era of the coronavirus-19 pandemic and beyond

“…Hence, the standard practice is to observe patients 24-48 h after the procedure for new or worsening conduction abnormalities[ 30 ]. However, with the COVID-19 pandemic and the patient population undergoing TAVR usually being elderly with multiple co-morbidities placing them at higher risk of COVID-19 related complications, several studies sought and reported on SDD following TAVR[ 6 , 31 , 32 ].…”

“…Rai et al [ 32 ] reported their experience of SDD based on 6 patients with severe symptomatic AS or bio-prosthetic valve dysfunction and proposed an SDD protocol. Since the major barrier to discharge patients after TAVR is related to new or worsening conduction abnormalities, they hypothesized that having a pre-procedure PPM or discharge with real-time continuous monitoring could allow for safe SDD.…”

Never Let a Crisis Go to Waste: What Have We Learned About Clinical Pathways for Transcatheter Structural Heart Interventions?

“… 4 Founded on the Vancouver 3M 6 and Benchmark 7 pathway, their protocol is described in detail and aims to improve outcomes while minimizing resource utilization along the continuum of care. Four series 8 , 9 , 10 , 11 have demonstrated safety of SDD in select patients; Krishnaswamy et al presented the largest series of SDD in 444 patients at Transcatheter Cardiovascular Therapeutics on November 5, 2021. 11 These single-center studies beg several questions.…”