A Prospective Analysis of Early Discharge after Transfemoral Transcatheter Aortic Valve Implantation

• Published in: The American journal of cardiology 2016-09, Vol.118 (6), p.866-872
• Main Authors: Serletis-Bizios, Anna, MD, Durand, Eric, MD PhD, Cellier, Guillaume, MD, Tron, Christophe, MD, Bauer, Fabrice, MD PhD, Glinel, Bastien, MD, Dacher, Jean-Nicolas, MD, Cribier, Alain, MD, Eltchaninoff, Helene, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - surgery; Blood Transfusion - statistics & numerical data; Blood transfusions; Cardiovascular; Confidence intervals; Electrocardiography; Feasibility Studies; Female; Femoral Artery; France; Heart attacks; Heart failure; Hospitalization; Humans; Kidneys; Length of Stay - statistics & numerical data; Logistics; Male; Mortality; Multivariate Analysis; Pacemaker, Artificial - statistics & numerical data; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Patient Safety; Patients; Population; Proportional Hazards Models; Prospective Studies; Pulmonary arteries; Risk Factors; Studies; Time Factors; Transcatheter Aortic Valve Replacement; Ultrasonic imaging
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.06.035

Abstract As transcatheter aortic valve implantation (TAVI) becomes more routinely employed, the recommended duration of monitoring after uncomplicated TAVI remains indeterminate. Retrospective analysis suggests discharge within 72 hours is safe, but prospective data is largely lacking. We therefore prospectively assess the feasibility and safety of early discharge (within 72 hours) after transfemoral TAVI using Edwards SAPIEN-XT and SAPIEN-3 prostheses. Patients undergoing elective transfemoral TAVI were assessed prospectively for early discharge home. Feasibility and safety (death or repeat hospitalization within 30 days of discharge) of early discharge were assessed. Causes for failure of early discharge were assessed by prospective data collection and multivariate analysis. Of 130 patients, 76 (59%) were discharged early. Death or repeat hospitalization within 30 days occurred only in 4 (5%) cases among patients discharged early: repeat hospitalization within 30 days was required in 3 early-discharge patients (4%) and there was a single death at 30 days. By multivariate analysis, factors associated with delayed discharge were blood transfusion (hazard ratio [HR] 13.85, 95% confidence interval [CI]: 1.61 – 119.40, p = 0.017) and pacemaker implantation (HR 4.47, 95% CI: 1.34 – 14.26, p = 0.012). In conclusion, early discharge after elective transfemoral TAVI with SAPIEN-XT/SAPIEN-3 prostheses is safe and attainable in a large proportion of patients, with no evident compromise in safety. Factors associated with failure of early discharge are post-procedural blood transfusion and permanent pacemaker implantation.