Transfemoral- TAVR safe and efficient procedure for same day discharge

The covid-19 pandemic has taken lives uncountably and making patients critical. There has been huge scarcity for hospitalization and availability of beds within hospitals. Reducing hospital length of stay is an important goal for patients and hospitals.

A recent study JACC: Cardiovascular Interventions by Dr Amar Krishnaswamy MD and team evaluated the feasibility and safety of same-day discharge (SDD) following transfemoral transcatheter aortic valve replacement compared with next-day discharge (NDD).

The study retrospectively analyzed patients who underwent "minimalist" outpatient transfemoral transcatheter aortic valve replacement in 2019 to 2020. SDD was applied to patients who met the predefined criteria. Outcomes included in-hospital and 30-day events and were compared between same-day discharge and next-day discharge, during and prior to availability of the same day discharge pathway.

Results of the study found that

• In 2020, SDD and NDD accounted for 22.1% (n = 114 of 516) and 63.8% (n = 329 of 516) of outpatient TF-TAVR, respectively. SDD patients in 2020, compared with NDD patients in 2019 (n = 481), were younger, were more often male, and had a lower surgical risk.

• There was no significant differences in in-hospital events and 30-day readmissions were cardiovascular readmission was 3.5% vs 6.2%; and noncardiovascular readmission was 2.6% vs 4.0%; and there were no deaths after same day discharge.

• These outcomes remained consistent after propensity score matching. Only 1 (0.9%) patient required pacemaker implantation after same day discharge.

• As expected based on same day discharge criteria, multivariable logistic regression analysis identified procedure end-time as the strongest predictor of same day discharge, while male sex and baseline hemoglobin level were also associated with same day discharge.

Researchers concluded that same day discharge after transfemoral transcatheter aortic valve replacement was feasible in this early experience without impairing post-discharge safety. Our same day discharge pathway may serve as a useful strategy to improve bed utilization and reduce hospital stay for transcatheter aortic valve replacement recipients.

Reference: https://doi.org/10.1016/j.jcin.2022.01.013