Aims Early discharge after transcatheter aortic valve implantation (TAVI) may potentially impact post‐procedural safety of the patient. The study aim was to compare safety of TAVI in patients planned for fast track hospital stay with patients planned for standard hospital stay. Methods and results All‐comers patients undergoing transfemoral TAVI between 2011 and 2017 were allocated to two matched groups depending whether the procedure was performed before or after transition from standard to fast track course. Data on vital status and hospitalizations were obtained through national registries. Three hundred and nineteen matched pairs were eligible for analysis. The median length of post‐procedural stay was 3 days (IQR: 2–4) for patients in the fast track group compared to 6 days (IQR: 4–8) in the standard approach group (p < .0001). There was no difference in all‐cause mortality between groups at 30‐day (1.3% vs. 1.9%, p = .52) or 90‐day follow‐up (2.9% vs. 4.1%, p = .42). There was no difference in the risk of new permanent pacemaker implantation (PPI) in pacemaker naïve patients between groups at 30‐day (15.8% vs. 21.2%, p = .16) or 90‐day follow‐up (15.8% vs. 21.9%, p = .12). There was no difference in the rate of rehospitalization between groups between discharge and 90‐day follow‐up (2.09 per patient‐year vs. 2.09 per patient‐year, p = .99). Conclusions Early discharge in an all‐comers population undergoing transfemoral TAVI is safe with regards to all‐cause mortality, need for PPI, and rehospitalization.

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Background Previous studies have shown increased re-hospitalisation rates for patients treated with transcatheter aortic valve implantation (TAVI) within the first post-procedural year. Most of these may be due to pre-existing co-morbidities, periprocedural complications, or suboptimal post-discharge plan. However, data on re-hospitalisation causes and associations with the TAVI procedure are limited. Purpose The aims of this study were to assess the incidence and cause of re-hospitalisation in patients with severe, symptomatic aortic stenosis treated with TAVI. Methods All patients who underwent TAVI at our centre between 2016 and 2020 were followed at patient-level during the first year after index admission. The risk of re-hospitalisation was calculated after discharge from index admission. All patients' medical records were reviewed to validate the cause of re-hospitalisation and mortality according to The Valve Academic Research Consortium 3 definitions. Results In total, 1,482 consecutive patients had undergone TAVI from 2016 to 2020, of whom 79 patients were excluded due to aortic regurgitation, conversion to surgical aortic valve replacement during index admission or residing abroad. Thus, the total study population consisted of 1,403 patients with a median age of 80 years (IQR: 75–84 years). Median length of stay for the post-procedural index admission was 2 days (IQR: 1–3 days). The total rate of all-cause re-hospitalisation per 100 patient years was 2.7 within the first 30 days, 1.1 from day 31 to 90, and 0.8 from day 91 to the first-year post-discharge. Within the first post-discharge year, 48.6% of the patients were re-hospitalized at least once, of which 26.2% (CI: 23.9–28.5%) of the first re-hospitalisations were of cardiovascular cause compared to 22.4% (CI: 20.2–24.6%) of non-cardiovascular cause. Median length of stay for the first re-hospitalisation was 3 days (IQR: 2–7 days). The most common cardiovascular causes were arrhythmias (28.1% of which 40.6% led to permanent pacemaker implantation), heart failure (14.4%), and neurological events (14.4%). The most common non-cardiovascular causes were infectious diseases (18.3% with pneumonia accounting for 40.4% of these admissions). The first re-hospitalisation was elective in 14.8% of the admissions, primarily due to percutaneous left atrial appendage closure, cancer, or osteoarthritis. Conclusion Almost half of the patients treated with TAVI between 2016 and 2020 were re-hospitalized within the first year after the index admission. First post-procedural re-hospitalisation was more often due to cardiovascular than non-cardiovascular cause with arrhythmias accounting for approximately 30% of cardiovascular re-hospitalisations. Further work is needed to explore whether the rate and causes of hospitalisations differ in the general population and to potentially establish a risk model to predict patients at high-risk of re-hospitalisation. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Boston ScientificAbbott

Transcatheter aortic valve implantation (TAVR) is the first therapeutic option for elderly patients with severe symptomatic aortic stenosis, and indications are steadily expanding to younger patients and subjects with lower surgical risk and longer life expectancy. Commissural alignment between native and transcatheter valves facilitates coronary access after TAVR and is thus considered a procedural goal, allowing long-term management of coronary artery disease. Moreover, commissural alignment may potentially have a positive impact on transvalvular hemodynamic and valve durability. This review focus on technical hints to achieve commissural alignment and current evidence for different transcatheter aortic valves.