Predictors and safety of next-day discharge in patients undergoing transfemoral transcatheter aortic valve implantation

Costa, Giuliano; Barbanti, Marco; Picci, Andrea; Todaro, Denise; Spina, Ketty La; Simone, Emanuela Di; D’Arrigo, Paolo; Criscione, Enrico; Valvo, Roberto; Reddavid, Claudia; Deste, Wanda; Sgroi, Carmelo; Tamburino, Corrado; Giuffrida, Angelo; Garretto, Valeria; Privitera, Gianbattista; Cannizzaro, Maria Teresa; Inserra, Maria Cristina; Veroux, Pierfrancesco

doi:10.4244/eij-d-19-01080

Cited by 19 publications

(11 citation statements)

References 19 publications

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“…Safety of SDD after TAVR is further supported by our findings of zero mortality, stroke, or rehospitalization by 30 days. Our data aligns with prior studies of TAVR showing similar low risk of mortality and stroke at 30 days after early discharge 2‐4 . There was a trend toward higher cardiovascular readmission rates in the NDD group (Table 5), although not achieving statistical significance, which we hypothesize is related to the larger sample size of the NDD group.…”

Section: Discussionsupporting

confidence: 90%

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Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era

Perdoncin

Greenbaum

Grubb

et al. 2020

Cathet Cardio Intervent

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Objectives We sought to evaluate the safety, efficacy and feasibility of same‐day discharge after uncomplicated, minimalist TAVR. Background At the start of the COVID‐19 pandemic, we created a same‐day discharge (SDD) pathway after conscious sedation, transfemoral (minimalist) TAVR to help minimize risk of viral transmission and conserve hospital resources. Studies support that next‐day discharge (NDD) for carefully selected patients following minimalist TAVR is safe and feasible. There is a paucity of data regarding the safety of SDD after TAVR. Methods In‐hospital and 30 day outcomes of consecutive patients meeting pre‐specified criteria for SDD after minimalist TAVR at our institution between March and July of 2020 were reviewed. Outcomes were compared to a NDD cohort from July 2018 through July 2020 that would have met SDD criteria. Primary endpoints were mortality, delayed pacemaker placement, stroke and cardiovascular readmission at 30 days. Results Twenty nine patients were discharged via the SDD pathway after TAVR. 128 prior NDD patients were identified who met all criteria for SDD. The STS scores were similar between the two groups (SDD 2.6% ±1.5 vs. NDD 2.3% ± 1.2). There were no deaths at 30 days in either group. There was no significant difference in delayed pacemaker placement (SDD 0% vs. NDD 0.8%, p > .99) or cardiovascular readmission (SDD 0% vs. NDD 5.5%, p = .35) at 30 days. Conclusions Same day discharge following uncomplicated, minimalist TAVR in selected patients appears to be safe, achieving similar 30 day outcomes as a cohort of next day discharge patients.

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Section: Discussionsupporting

confidence: 90%

“…Previous studies have shown that next day discharge (NDD) for carefully selected patients undergoing minimalist TAVR is safe and feasible 2‐5 . There is a paucity of data regarding the safety and feasibility of SDD after TAVR.…”

Section: Introductionmentioning

confidence: 99%

Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era

Perdoncin

Greenbaum

Grubb

et al. 2020

Cathet Cardio Intervent

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“…This strategy allowed to reduce staff and patients potential exposure to COVID-19 infection, and to lower health system overload by performing a single hospitalization for both TAVI workup and procedure and optimizing in-hospital length of stay. Accordingly, a next-day discharge strategy was the standard pathway for uncomplicated TAVI without predictors of developing complete atrio-ventricular block during the pandemic, once again aiming at minimizing in-hospital length of stay [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Transcatheter aortic valve implantation during COVID-19 pandemic: An optimized model to relieve healthcare system overload

Reddavid

Costa

Valvo

et al. 2022

International Journal of Cardiology

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Background The coronavirus 2019 (COVID-19) pandemic upset healthcare systems and their logistics worldwide. We sought to assess safety and effectiveness of an optimized logistics for transcatheter aortic valve implantation (TAVI) pathway developed during the COVID-19 pandemic. Methods This is a retrospective analysis. An optimized TAVI logistics based on performing TAVI work-up and procedure during the same hospitalization was used during the COVID-19 pandemic. In-hospital and 30-day outcomes of patients treated during the pandemic were compared with an historical cohort of patients undergoing TAVI with staged work-up before the pandemic within an homogeneous timeframe. Results Of 536 patients, 227 (42.4%) underwent TAVI during the COVID-19 pandemic with a reduction of 26.5% compared to the pre-pandemic period ( n = 309). The median age was 81 (77–85) years and STS score was 3.4 (2.2–5.6)%. Lower rates of in-hospital major vascular complications (2.2% vs. 8.7%; p < 0.01) and life-threatening bleeding (0.4% vs. 4.2%; p = 0.01) were reported in the COVID-19 period, whereas no difference in acute kidney injury (7.0% vs. 7.4%, p = 0.85) rate was reported between COVID-19 and pre-COVID-19 periods. No difference in 30-day rates of all-cause death (4.0 vs. 4.5, p = 0.75) and of major adverse cardiovascular events (4.0 vs. 6.1, p = 0.26) were reported between COVID-19 and pre-COVID-19 periods. Conclusions The use of optimized single-hospitalization logistics for TAVI workup and procedure developed during the COVID-19 pandemic, showed to be as safe and effective as the two-stage TAVI pathway previously adopted, allowing the minimization of potential exposure to COVID-19 infection and shortening times to treatment for severely symptomatic patients.

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“…Besides the changes in TAVI patient characteristics, over the past decade, we have witnessed the optimization of the TAVI procedure and of the care pathways, which have been shown to impact early and mid-term outcomes [ 9 , 10 , 11 ]. Indeed, advancements in TAVI devices, a better pre-procedural assessment due to the widespread adoption of ECG-gated computed tomography angiography (CTA), as well as optimization in post-procedural care, largely showed improvements in procedural outcomes and allowed a more rapid discharge with a lower utilization of hospital resources.…”

Section: Discussionmentioning

confidence: 99%

One-Year Outcomes and Trends over Two Eras of Transcatheter Aortic Valve Implantation in Real-World Practice

Costa

D’Errigo

Rosato

et al. 2022

JCM

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Background: Data reflecting the benefit of procedural improvements in real-world transcatheter aortic valve implantation (TAVI) practice are sparse. Aims: To compare outcomes and trends of two TAVI eras from real Italian practice. Methods: A total of 1811 and 2939 TAVI patients enrolled in the national, prospective OBSERVANT and OBSERVANT II studies in 2010–2012 and 2016–2018, respectively, were compared in a cohort study. Outcomes were adjusted using inverse propensity of treatment weighting and propensity score matching. Results: The median age (83.0 (79.0–86.0) vs. 83.0 (79.0–86.0)) and EuroSCORE II (5.2 (3.2–7.7) vs. 5.1 (3.1–8.1)) of OBSERVANT and OBSERVANT II patients were similar. At 1 year, patients of the OBSERVANT II study had a significantly lower risk of all-cause death (10.6% vs. 16.3%, Hazard Ratio (HR) 0.63 (95% Confidence Interval (CI) 0.52–0.76)) and rehospitalization for heart failure (HF) (14.3% vs. 19.5%, Sub-distribution HR 0.71 (95%CI 0.60–0.84)), whereas rates of stroke (3.1% vs. 3.6%) and permanent pacemaker implantation (PPI) (16.6% vs. 18.0%) were comparable between study groups. Conclusions: Age and risk profile among patients undergoing TAVI in Italy remained substantially unchanged between the 2010–2012 and 2016–2018 time periods. After adjustment, patients undergoing TAVI in the most recent era had lower risk of all-cause death and rehospitalization for HF at 1 year, whereas rates of stroke and PPI did not differ significantly.

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Predictors and safety of next-day discharge in patients undergoing transfemoral transcatheter aortic valve implantation

Cited by 19 publications

References 19 publications

Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era

Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era

Transcatheter aortic valve implantation during COVID-19 pandemic: An optimized model to relieve healthcare system overload

One-Year Outcomes and Trends over Two Eras of Transcatheter Aortic Valve Implantation in Real-World Practice

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