Factors associated with safe early discharge after transcatheter aortic valve implantation

Cardiol J. 2018;25(1):14-23. doi: 10.5603/CJ.a2017.0087. Epub 2017 Jul 17.

Abstract

Background: As transcatheter aortic valve implantation (TAVI) becomes more straightforward, a larger proportion of patients will be well enough to be discharged early. This study sought to charac-terise the clinical features that allowed patients to be discharged early after TAVI and to evaluate the safety of an early discharge policy.

Methods: All patients undergoing TAVI at the above cited center from August 2007 to March 2015 were included in this study. Baseline characteristics, in-hospital outcomes, re-admissions and mortality were compared.

Results: Three hundred thirty-seven TAVIs were performed during the study period, and 18 died in-hospital (18/337, 5.3%). Of the remaining patients, 56 were discharged within 3 days of the index procedure ('early discharge group' 56/319, 17.5%). There was no difference between the early discharge and late discharge group in terms of Valve Academic Research Consortium-2 (VARC-2) criteria out-comes, all-cause re-admission rates and the need for permanent pacemaker implantation. Mortality at 1 year was better among the early discharge group (3.6% vs. 15.6%, p = 0.014); a reflection of baseline clinical differences.

Conclusion: Early discharge of clinically selected TAVI patients is safe and appropriate. Lower logistic EuroSCORE, smaller delta creatinine and not developing any complications are factors associated with early discharge. (Cardiol J 2018; 25, 1: 14-23).

Keywords: Valve Academic Research Consortium-2 (VARC-2); early discharge; re-admissions; safety; transcatheter aortic valve implantation; transcatheter aortic valve replacement.

MeSH terms

  • Aged, 80 and over
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Patient Discharge / trends*
  • Postoperative Complications / epidemiology*
  • Registries*
  • Retrospective Studies
  • Risk Assessment*
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Transcatheter Aortic Valve Replacement / methods*
  • Treatment Outcome
  • United Kingdom / epidemiology