FAST-TAVI II - FAST-TAVI II

Apr 01, 2024
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Trial Sponsor:
French Government
Date Published:
03/04/2024
Date Updated:
04/01/2024
Original Posted Date:
04/02/2024
References

Contribution To Literature:

The FAST-TAVI II trial showed that a training program reduces length of stay after TAVI compared with usual care.

Description:

The goal of the trial was to evaluate a training program aimed to reduce length of stay after transfemoral transcatheter aortic valve implantation (TAVI) compared with usual care.

Study Design

  • Cluster
  • Randomized
  • Parallel

Patients undergoing transfemoral TAVI were randomized to intervention (n = 969) vs. usual care (n = 860). The intervention group consisted of patient/family education, medical/paramedical team education, daily monitoring of the patient, postoperative echocardiography on day 0 or 1, use of a decision tree for conduction disturbance, ultrasound-guided arterial access and closure, early mobilization, prevention of bleeding complications, and prevention of acute kidney injury.

  • Total number of enrollees: 1,829
  • Duration of follow-up: 30 days
  • Mean patient age: 81.9 years
  • Percentage female: 45%
  • Percentage with diabetes: 30%

Inclusion criteria:

  • At least 18 years of age with symptomatic severe aortic stenosis
  • Scheduled for transfemoral TAVI

Exclusion criteria:

  • Unable to provide informed consent
  • Pregnancy

Principal Findings:

The primary outcome, early discharge (within 3 days), was 58.1% in the intervention group vs. 42.3% in the usual care group (p < 0.0001).

Secondary outcomes:

  • Median length of stay: 3 days in the intervention group vs. 4 days in the usual care group (p < 0.0001)
  • 30-day mortality: 0.5% in the intervention group vs. 0.9% in the usual care group (p = 0.30)
  • 30-day readmissions: 4.6% in the intervention group vs. 2.8% in the usual care group (p = 0.28)

Interpretation:

Among patients undergoing TAVI, a 10-point intervention program improved the proportion of patients discharged within 3 days compared with usual care. The intervention program was associated with a shorter median length of stay compared with usual care. Mortality and readmissions within 30 days were similar between treatment groups.

References:

Durand E, Beziau-Gasnier D, Michel M, et al. Reducing length of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial. Eur Heart J 2024;45:952-62.

Editorial Comment: Mehilli J. Shortening in-hospital stay after transcatheter aortic valve implantation: a déjà vu in percutaneous interventions. Eur Heart J 2024;45:963-5.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Length of Stay, Transcatheter Aortic Valve Replacement


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