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Feasibility of Same-Day Discharge After Transfemoral TAVR
Quick Takes
- In select patients, same-day discharge after transfemoral TAVR is safe and feasible.
- Minimalist TAVR using conscious sedation, absence of major procedural complications, appropriate monitoring post-procedure, and adequate support at home after discharge are criteria that could identify patients for safe same-day discharge after TAVR.
Study Questions:
What is the safety and feasibility of same-day discharge (SDD) after transfemoral transcatheter aortic valve replacement (TF-TAVR)?
Methods:
This was a retrospective, single-center analysis of patients who underwent “minimalist” outpatient TF-TAVR in 2019–2020. SDD was applied to patients who met the predefined criteria. Outcomes included in-hospital and 30-day events and were compared between SDD and next-day discharge (NDD) (during and prior to availability of the SDD pathway).
Results:
In 2020, SDD and NDD accounted for 22.1% (114/516) and 63.8% (329/516) of outpatient TF-TAVR, respectively. SDD patients in 2020, compared with NDD patients in 2019 (n = 481), were younger, more often male, and had a lower surgical risk. There were no significant differences in in-hospital events and 30-day readmissions (cardiovascular readmission 3.5% vs. 6.2%, p = 0.37; noncardiovascular readmission, 2.6% vs. 4.0%, p = 0.78) and there were no deaths after SDD. These outcomes remained consistent after propensity-score matching. Only one (0.9%) patient required pacemaker implantation after SDD (post-TAVR day 25). As expected based on SDD criteria, multivariable logistic regression analysis identified procedure end-time as the strongest predictor of SDD (adjusted odds ratio, 7.74; 95% confidence interval, 4.39-13.63), while male sex and baseline hemoglobin level were also associated with SDD.
Conclusions:
SDD after TF-TAVR was feasible in this early experience without impairing post-discharge safety. This SDD pathway may serve as a useful strategy to improve bed utilization and reduce hospital stay for TAVR recipients.
Perspective:
This single-center, retrospective study from a high-volume TAVR center evaluated the safety and feasibility of SDD in select patients after TF-TAVR. There was no significant difference in clinical outcomes among those discharged the same day or next day after TAVR. The authors outline a SDD criteria, which includes minimalist TAVR using conscious sedation, no major procedural complications, appropriate monitoring post-procedure, and adequate support at home after discharge. This study is limited by the small number of SDD patients (n = 114); however, it paves the way for a larger randomized study to prove the safety of SDD in select patients undergoing TAVR.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Structural Heart Disease
Keywords: Aortic Valve Stenosis, Cardiac Surgical Procedures, Conscious Sedation, Hemoglobins, Heart Valve Diseases, Length of Stay, Outpatients, Pacemaker, Artificial, Patient Discharge, Patient Readmission, Transcatheter Aortic Valve Replacement
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