Next-Day Discharge after TAVR: Equally Safe for All Prosthesis?

Yet scarce, there is evidence supporting next-day discharge (NDD) after TAVR is safe when patients receiving balloon expandable valves meet certain conditions. This had not yet been shown for self-expandable valves. This study looks into NDD after TAVR by femoral access with self-expandable valves. 

El alta en el mismo día luego de una angioplastia coronaria es cada vez más popular pero todavía no es regla

The authors retrospectively compared all consecutive patients undergoing elective minimalist TAVR between January 2017 and July 2018. They looked at next-day discharge success rate and the factors that prevent this from happening.

In addition, results were compared at 90 days and one year after next-day discharge with self-expandable ACURATE neo and balloon expandable SAPIEN 3.


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During this period, 315 valves were implanted, 146 patients received the ACURATE neo and 103 received the SAPIEN 3.

60% of ACURATE neo patients (n=87) and 55% of the SAPIEN 3 patients (n=57) were discharged the next day after TAVR, which makes no significant difference.

Predictors preventing NDD after TAVR were chronic obstructive pulmonary disease (OR: 0.49) and baseline anemia (OR 0.98), but not valve type.


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After excluding cases with more hospitalization days, there were no differences at 90 days in mortality (0% vs 0%) or new pacemaker implantation (1% vs 0%); p=0.40) between both devices. Something similar was observed with mortality at one year (8% vs 10%; p>0.8).

Conclusion

Safety of NDD using the self-expandable ACURATE neo was similar to NDD with SAPIEN 3, with comparable results at 90 days and one year.

Original Title: Safety of Next-Day Discharge After Transfemoral Transcatheter Aortic Valve Replacement With a Self-Expandable Versus Balloon-Expandable Valve Prosthesis.

Reference: Moriyama N et al. Circ Cardiovasc Interv. 2019 Jun;12(6):e007756.


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