Next-Day Discharge after TAVR: Is It Viable?

Next-day discharge after transfemoral transcatheter aortic valve replacement (TAVR) might be viable, with no major complications at 30 days or one year, compared against patients with longer hospital stay. We only have to consider a few factors that will help us choose the most adequate patients for this modality without compromising safety.

One of the main advantages of TAVR is a faster recovery post procedure, compared to patients undergoing conventional surgery. Our passionate inquisitive nature imposed the minimalist approach with conscious sedation, local anesthesia, transthoracic ECG and femoral access site. All of this made us dream with early discharge, but next day discharged seemed too far-fetched, even for the most optimistic.

The study included 663 consecutive patients undergoing TAVR with balloon-expandable valve in one center. The aim was to determine predictors of next day discharge in patients receiving minimalist transfemoral TAVR, in addition to comparing 30 day and one year outcomes against patients with longer hospital stay, after excluding all cases with complications. Primary end point was a composite of mortality and readmission at 1 year.

A total of 150 patients were discharged the next day of procedure and 210 remained hospitalized. Population mean age was 80.7 ± 8.8 years and mean STS was 6.6 ± 3.7%.

Read also: Transradial Access and Early Discharge in Percutaneous Interventions.

Predictors of next day discharge were male sex (OR 2.02), absence of atrial fibrillation (OR 1.62), serum creatinine (OR 0.71), and age (OR 0.95).

As expected, 84% of patients with complications remained hospitalized. After excluding patients with complications, there were no differences at 30 days between next day discharge patients and those that stayed longer. However, at one year follow up the combined end point was significantly lower in the next day discharge group (HR 0.47). This difference can be due to the lower risk of non-cardiovascular related readmission in the next day discharge group.

Conclusion

Among uncomplicated patients undergoing TAVR, there was a similar events rate at 30 days between patients discharged the next day after procedure and patients that stayed longer. At one year, events rate was significantly lower for those with early discharge.

Original title: Predictors and Clinical Outcomes of Next-Day Discharge After Minimalist Transfemoral Transcatheter Aortic Valve Replacement.

Reference: Norihiko Kamioka et al. J Am Coll Cardiol Intv 2018;11:107–15.

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