A pathway to earlier discharge following TAVI: Assessment of safety and resource utilization

Noad, Rebecca L; Johnston, Nicola; McKinley, Andrew; Dougherty, Mark; Nzewi, Onyekwelu; Jeganathan, Reuben; Manoharan, Ganesh; Spence, Mark S.

doi:10.1002/ccd.26005

Cited by 37 publications

(14 citation statements)

References 11 publications

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“…In light of these favorable results, early discharge after TAVR has been proposed to increase patient comfort and the cost effectiveness of the procedure (5)(6)(7). However, delayed high-degree atrioventricular block (AVB) after TAVR remains a feared complication (8).…”

mentioning

confidence: 99%

The Electrocardiogram After Transcatheter Aortic Valve Replacement Determines the Risk for Post-Procedural High-Degree AV Block and the Need for Telemetry Monitoring

Toggweiler

Stortecky

Holy³

et al. 2016

JACC: Cardiovascular Interventions

125

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mentioning

confidence: 99%

The Electrocardiogram After Transcatheter Aortic Valve Replacement Determines the Risk for Post-Procedural High-Degree AV Block and the Need for Telemetry Monitoring

Toggweiler

Stortecky

Holy³

et al. 2016

JACC: Cardiovascular Interventions

125

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“…Importantly, there is no significant increase in significant PVR, major complications or mortality with minimalist TAVR [13,[42][43][44][45][47][48][49][50]. These profound effects on patient care have led to the development of care pathways to improve and expedite safe and high-quality post-procedure TAVR care [51][52][53][54][55].…”

Section: Outcome Comparison Between Intraprocedural Tte Versus Teementioning

confidence: 99%

The transition from transesophageal to transthoracic echocardiography during transcatheter aortic valve replacement: an evolving field

2018

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The advent of transcatheter aortic valve replacement (TAVR) has dramatically transformed the clinical approach to severe aortic stenosis. Over the last decade, several trials have shown the equivalence or even superiority of transcatheter valve replacement over the conventional surgical approach. As a result, TAVR as a treatment for severe, symptomatic aortic stenosis has rapidly extended from inoperable or prohibited-risk patients to intermediate-risk patients. The success of TAVR has led to the wide adaptation of this technique and, subsequently, a significant increase in the number of these procedures performed annually. As the number of these procedures is expected to further increase, especially if its indication will include those with low surgical risk, there is a great demand to improve patient recovery and early discharge without compromising outcomes. In this review, we will discuss the role of echocardiography in the perioperative planning and assessment of transcatheter aortic valve replacement. In addition, we will review the current evidence behind the use of intraprocedureal transthoracic echocardiography and the recommended steps for successful transition from transesophageal to transthoracic echocardiography.

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“…While no death occurred in the patients that were discharged after 72 h, 7 required rehospitalisation. In a cohort of 120 patients that underwent TAVI at a single centre, 21.7% of patients were discharged on either the same day as the procedure or the following day, with a further 32.5% discharged at 2 or 3 days [ 6 ]. There were no deaths within 30 days for any of these patients, while mortality was 5.5% for those that were discharged after 4 days.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation – rationale and design of the FAST-TAVI registry

Barbanti

Baan

Spence

et al. 2017

BMC Cardiovasc Disord

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BackgroundThere is an increasing trend towards shorter hospital stays after transcatheter aortic valve implantation (TAVI), in particular for patients undergoing the procedure via transfemoral (TF) access. Preliminary data suggest that there exists a population of patients that can be discharged safely very early after TF-TAVI. However, current evidence is limited to few retrospective studies, encompassing relatively small sample sizes.MethodsThe Feasibility And Safety of early discharge after Transfemoral TAVI (FAST-TAVI) registry is a prospective observational registry that will be conducted at 10 sites across Italy, the Netherlands and the UK. Patients will be included if they have been scheduled to undergo TF-TAVI with the balloon-expandable SAPIEN 3 transcatheter heart valve (THV; Edwards Lifesciences, Irvine, CA). The primary endpoint is a composite of all-cause mortality, vascular-access-related complications, permanent pacemaker implantation, stroke, re-hospitalisation due to cardiac reasons, kidney failure and major bleeding, occurring during the first 30 days after hospital discharge. Patients will be stratified according to whether they were high or low risk for early discharge (≤3 days) (following pre-specified criteria), and according to whether or not they were discharged early. Secondary endpoints will include time-to-event (Kaplan–Meier) analysis for the primary outcome and its individual components, analysis of the relative costs of early and late discharge, and changes in short- and long-term quality of life. Multivariate logistic regression will be used to identify factors that indicate that a patient may be suitable for early discharge.DiscussionThe data gathered in the FAST-TAVI registry should help to clarify the safety of early discharge after TF-TAVI and to identify patient and procedural characteristics that make early discharge from hospital a safe and cost-effective strategy.Trial registrationClinicalTrials.gov Identifier: NCT02404467 (registration first received March 23rd 2015).

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A pathway to earlier discharge following TAVI: Assessment of safety and resource utilization

Abstract: Same/next day discharge can be performed safely in appropriately selected patients. Although this will be achieved in a minority of patients (21.7% in this study using an early discharge pathway) it has potential for resource and cost savings. © 2015 Wiley Periodicals, Inc.

Cited by 37 publications

References 11 publications

The Electrocardiogram After Transcatheter Aortic Valve Replacement Determines the Risk for Post-Procedural High-Degree AV Block and the Need for Telemetry Monitoring

The Electrocardiogram After Transcatheter Aortic Valve Replacement Determines the Risk for Post-Procedural High-Degree AV Block and the Need for Telemetry Monitoring

The transition from transesophageal to transthoracic echocardiography during transcatheter aortic valve replacement: an evolving field

Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation – rationale and design of the FAST-TAVI registry

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