Early Discharge After TAVR | Journal Scan
What are the feasibility and predictors of early discharge (within 72 hours) after transfemoral transcatheter aortic valve replacement (TAVR)?
The authors assessed the course of 500 high-risk or inoperable patients with symptomatic severe aortic stenosis who underwent transfemoral TAVR at a single Italian center. Patients discharged within 72 hours of TAVR (early discharge group) were compared with those discharged after 3 days. Propensity-matching was used to compare patients with early versus late discharge.
The study cohort was comprised of 465 patients who were discharged alive after TAVR. Of this group, 107 (23.0%) were discharged within 3 days of the procedure. Preprocedural New York Heart Association (NYHA) class IV (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.05-0.96; p = 0.045) and any bleeding (OR, 0.31; 95% CI, 0.74-0.92; p = 0.031) were less likely to be associated with early discharge after TAVR. Factors favoring early discharge were the year of procedure (OR, 1.66; 95% CI, 1.25-2.20; p < 0.001) and the presence of a permanent pacemaker (PPM) before TAVR (OR, 2.80; 95% CI, 1.36-5.75; p = 0.005). After discharge, there was no significant difference between the two groups in terms of death (2.2% vs. 1.7%, p = 0.540), bleeding (0.0% vs. 1.1%, p = 0.444), PPM implantation (1.1% vs. 0.0%, p = 0.333), and re-hospitalization (1.1% vs. 1.1%, p = 1.000) at 30 days.
A significant proportion of patients can be safely discharged early after TAVI, and they have a similar outcome compared with those discharged late.
With growing experience with TAVR, there has been considerable refinement of procedure and care processes, and the periprocedural care of these patients is being rapidly streamlined. The median length of stay in the early experience with TAVR in the TVT registry was 6 days, but anecdotally, an increasing number of patients are being discharged sooner. This study suggests that early discharge (within 72 hours of the procedure) can be safely accomplished in a significant number of patients, and this proportion is likely to increase as the procedure is adopted in a healthier population.
Keywords: Aortic Valve Stenosis, Cardiac Surgical Procedures, Cohort Studies, Hospitalization, Length of Stay, Pacemaker, Artificial, Patient Discharge, Transcatheter Aortic Valve Replacement
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