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. 

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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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