Author + information
- Received February 26, 2018
- Revision received April 18, 2018
- Accepted April 21, 2018
- Published online September 3, 2018.
- Rafail A. Kotronias, MBChB, MSca,b,
- Michael Teitelbaum, MDc,
- John G. Webb, MDd,
- Darren Mylotte, MBBCh, MDe,
- Marco Barbanti, MD, PhDf,
- David A. Wood, MDd,
- Brennan Ballantyne, MDc,
- Alyson Osborne, MDc,
- Karla Solo, MScg,
- Chun Shing Kwok, MBBS, MSca,h,
- Mamas A. Mamas, BMBCh, DPhila,h and
- Rodrigo Bagur, MD, PhDa,c,g,∗ ()
- aKeele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- bOxford University Clinical Academic Graduate School, Oxford University, Oxford, United Kingdom
- cLondon Health Sciences Centre, London, Ontario, Canada
- dCentre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- eGalway University Hospitals, National University of Ireland, Galway, Ireland
- fDivision of Cardiology, Cardio-Thoracic-Vascular Department, University of Catania, Catania, Italy
- gDepartment of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- hThe Heart Centre, Royal Stoke Hospital, University Hospital of North Midlands Trust, Stoke-on-Trent, United Kingdom
- ↵∗Address for correspondence:
Dr. Rodrigo Bagur, University Hospital, London Health Sciences Centre, Western University, 339 Windermere Road, N6A 5A5 London, Ontario, Canada.
Objectives This study sought to assess the clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) with early discharge (ED) versus standard discharge (SD) pathways.
Background Minimalist approaches for TAVR have been developed targeting different aspects of the procedure such as local anesthesia or sedation, intraprocedural imaging, vascular access, post-operative monitoring and care, and discharge planning. Their incorporation into routine clinical practice aims to reduce length of hospital stay and health care cost utilization without adversely affecting outcomes when compared with standard approaches.
Methods The authors conducted a search of MEDLINE and EMBASE to identify studies that investigated ED (≤3 days) versus SD in TAVR patients. Random-effects meta-analyses were used to estimate the effect of ED compared with SD with regard to 30-day mortality after discharge, 30-day readmission rate, and need for permanent pacemaker implantation (PPI) following discharge.
Results Eight studies including 1,775 participants (ED, n = 642) fulfilled the inclusion criteria. The mean age was 82.4 years and STS score was 6.7. Meta-analyses evaluating discharge to 30-day mortality (odds ratio [OR]: 0.65; 95% confidence interval [CI]: 0.23 to 1.82; I2 = 0%) and discharge to 30-day new PPI (OR: 1.61; 95% CI: 0.19 to 13.71; I2 = 40%) showed no significant difference in an ED compared with a SD strategy. Notably, ED patients were less likely to be readmitted after ED when compared with SD patients (OR: 0.63; 95% CI: 0.41 to 0.98; p = 0.04, I2 = 0%).
Conclusions ED following uncomplicated TAVR is safe in terms of discharge to 30-day mortality or need for PPI following discharge. Moreover, ED patients experienced a lower rate of readmissions. These data support the safety of programs aiming an ED pathway in selected TAVR patients. Institutional protocols with the input from different members of the multidisciplinary heart team should be devised to optimize discharge processes to improve health care resource utilization.
Dr. Webb has been a consultant to Edwards Lifesciences and Abbott Vascular. Dr. Mylotte has been a proctor and consultant for Medtronic and Microport. Dr. Barbanti has been a consultant to Edwards Lifesciences. Dr. Wood has received grant support form Edwards Lifesciences and Abbott Vascular; and has been a consultant to Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 26, 2018.
- Revision received April 18, 2018.
- Accepted April 21, 2018.
- 2018 American College of Cardiology Foundation