Abstract 16526: Is Early Discharge Feasible and Safe After Transfemoral Transcatheter Aortic Valve Replacement?
Background: Length of stay after transcatheter aortic valve replacement (TAVR), as for most medical conditions, is more a product of historical precedent than medical evidence. Shorter hospital stays may be cost-effectiveness and is also supported by the belief that some fraction of the conventional hospitalization may be inefficient, in particular in old and frail patients. We therefore aimed to evaluate the feasibility and the safety of early (i.e., within 3 days) discharge after TAVR.
Methods: Between october 2009 and april 2013, 254 consecutive patients underwent transfemoral TAVR in our institution, all performed using local anesthesia. All the patients were monitored in intensive care unit at least for 24 hours after TAVR. Fourteen (5.5%) patients died before discharge, and were excluded from this study. The remaining 240 patients were discharged at home, 78 (32.5%) within 3 days (early discharge group, EDG) and 162 (67.5%) more than 3 days after TAVR (conventional discharge group, CDG). The primary end point combined death and re-hospitalization at 30 days. All adverse events were adjudicated according to the Valve Academic Research Consortium.
Results: Before TAVR, patients in the EDG were less symptomatic and had less renal failure, atrial fibrillation, and previous balloon aortic valvuloplasty than those in the CDG. In contrast, patients in the EDG were more likely to have a pacemaker before TAVR. Patients in the EDG had less frequently major vascular (3.8% vs. 17.9%, p=0.0002) and life-threatening or major bleedings (3.8% vs. 13%, p=0.006) complications than those in the CDG. No patient died at 30 days in the EDG, while one patient died in the CDG (p=0.43). The primary end-point occurred in 4 (5.1%) patients in the EDG and in 11 (6.8%) patients in the CDG (p=0.60).
Conclusions: The results of our study suggest that early discharge after TAVR using local anesthesia is feasible and safe in patients with severe aortic stenosis without major complications immediately after TAVR.
- © 2013 by American Heart Association, Inc.