Factors associated with safe early discharge after transcatheter aortic valve implantation
Abstract
Background: As transcatheter aortic valve implantation (TAVI) becomes more straightforward, a larger proportion of patients will be well enough to be discharged early. This study sought to characterise the clinical features that allowed patients to be discharged early after TAVI and to evaluate the safety of an early discharge policy.
Methods: All patients undergoing TAVI at the above cited center from August 2007 to March 2015 were included in this study. Baseline characteristics, in-hospital outcomes, re-admissions and mortality were compared.
Results: Three hundred thirty-seven TAVIs were performed during the study period, and 18 died in-hospital (18/337, 5.3%). Of the remaining patients, 56 were discharged within 3 days of the index procedure (‘early discharge group’ 56/319, 17.5%). There was no difference between the early discharge and late discharge group in terms of Valve Academic Research Consortium-2 (VARC-2) criteria outcomes, all-cause re-admission rates and the need for permanent pacemaker implantation. Mortality at 1 year was better among the early discharge group (3.6% vs. 15.6%, p = 0.014); a reflection of baseline clinical differences.
Conclusion: Early discharge of clinically selected TAVI patients is safe and appropriate. Lower logistic EuroSCORE, smaller delta creatinine and not developing any complications are factors associated with early discharge. (Cardiol J 2018; 25, 1: 14–23)
Keywords: transcatheter aortic valve implantationtranscatheter aortic valve replacementearly dischargeValve Academic Research Consortium-2 (VARC-2)safetyre-admissions
References
- Leon MB, Smith CR, Mack MJ, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016; 374: 1609–1620.
- Fairbairn TA, Meads DM, Hulme C, et al. The cost-effectiveness of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at high operative risk. Heart. 2013; 99(13): 914–920.
- Kappetein A, Head S, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation. J Am Coll Cardiol. 2012; 60(15): 1438–1454.
- Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007; 165(6): 710–718.
- Durand E, Eltchaninoff H, Canville A, et al. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis. Am J Cardiol. 2015; 115(8): 1116–1122.
- Barbanti M, Capranzano P, Ohno Y, et al. Early discharge after transfemoral transcatheter aortic valve implantation. Heart. 2015; 101(18): 1485–1490.
- Khawaja MZ, Rajani R, Cook A, et al. Permanent pacemaker insertion after CoreValve transcatheter aortic valve implantation: incidence and contributing factors (the UK CoreValve Collaborative). Circulation. 2011; 123(9): 951–960.
- Franzoni I, Latib A, Maisano F, et al. Comparison of incidence and predictors of left bundle branch block after transcatheter aortic valve implantation using the CoreValve versus the Edwards valve. Am J Cardiol. 2013; 112(4): 554–559.
- Wendler O, Maccarthy P. Renal failure after transcatheter aortic valve implantation: do we know the full story? J Am Coll Cardiol. 2013; 62(10): 878–880.
- Yamamoto M, Hayashida K, Mouillet G, et al. Prognostic value of chronic kidney disease after transcatheter aortic valve implantation. J Am Coll Cardiol. 2013; 62(10): 869–877.
- Wessely M, Rau S, Lange P, et al. Chronic kidney disease is not associated with a higher risk for mortality or acute kidney injury in transcatheter aortic valve implantation. Nephrol Dial Transplant. 2012; 27(9): 3502–3508.
- Babaliaros V, Devireddy C, Lerakis S, et al. Comparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): outcomes and cost analysis. JACC Cardiovasc Interv. 2014; 7(8): 898–904.
