For over a decade, TAVR has been showing great benefits, but conduction abnormalities such as RBBB and prior A-V block, continue to be one of the biggest challenges, since in different series the need for definite pacemaker implantation (PPM) varies between 17 to 30% in the large, randomized studies of self-expanding valves.
Even though we are well aware a higher implantation depth of the percutaneous valve (cusp overlapping) has been shown to significantly reduce the need for PPM, it has not yet been tested in large, randomized studies.
68,482 patients receiving TAVR via femoral approach were looked at. 20,261 (29.6%) of these patients got early discharge (ED), between 0 and 1 day, and 48,221 late discharge (LD), ≥2 days.
Primary end point was rehospitalization for PPM.
ED patients were younger (79 ± 8 years vs. 80 ± 7.6 years p < 0.01), there were more men, fewer were diabetic or presented kidney failure, COPD, peripheral vascular disease, or stroke, and had more programmed procedures. Besides, they presented fewer conduction abnormalities such as first and second-degree AV block, RBBB and fascicular blocks.
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There were no differences in primary end point between ED and LD patients (2.0% vs. 1.8%; adjusted odds ratio: 1.15; 95% confidence interval: 0.95–1.39; p=0.15). Neither were there differences in readmissions for PPM at 30 and 60 days, or between elective and non-elective readmission.
Mean time for readmission was 5 days, with no differences between ED and LD.
ED was associated to lower hospital expenses compared against LD.
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Predictors of PPM were 2-degree A-V block, fascicular blocks, RBBB and kidney failure.
Conclusion
Early and late discharge TAVR patients who did not require permanent pacemaker implantation during hospitalization showed similar readmission rate for pacemaker implantation.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Early versus late discharge after transcatheter aortic valve replacement and readmissions for permanent pacemaker implantation.
Reference: Ahmed M. Elzanaty, et al. Catheter Cardiovasc Interv. 2022;100:245–253.
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