Author + information
- Received April 26, 2017
- Revision received October 11, 2017
- Accepted October 17, 2017
- Published online January 15, 2018.
- Norihiko Kamioka, MDa,
- John Wells, MDa,
- Patricia Keegan, DNPa,
- Stamatios Lerakis, MDa,
- Jose Binongo, PhDb,
- Frank Corrigan, MDa,
- Jose Condado, MDa,
- Ateet Patel, MDa,
- Jessica Forcillo, MDc,
- Leslie Ogburn, NPa,
- Andy Dong, BSa,
- Hope Caughron, BAa,
- Amy Simone, PAc,
- Bradley Leshnower, MDc,
- Chandan Devireddy, MDa,
- Kreton Mavromatis, MDa,
- Robert Guyton, MDc,
- James Stewart, MDa,
- Vinod Thourani, MDc,
- Peter C. Block, MDa and
- Vasilis Babaliaros, MDa,∗ ()
- aDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- bRollins School of Public Health, Emory University, Atlanta, Georgia
- cDivision of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
- ↵∗Address for correspondence:
Dr. Vasilis Babaliaros, Emory University Hospital F606, 1364 Clifton Road, Atlanta, Georgia 30322.
Objectives This study sought to investigate predictors and safety of next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR).
Background Information about predictors and safety of NDD after TAVR is limited.
Methods The study reviewed 663 consecutive patients who underwent elective balloon-expandable TAVR (from July 2014 to July 2016) at our institution. We first determined predictors of NDD in patients who underwent minimalist transfemoral TAVR. After excluding cases with complications, we compared 30-day and 1-year outcomes between NDD patients and those with longer hospital stay using Cox regression adjusting for the Predicted Risk of Mortality provided by the Society of Thoracic Surgeons. The primary endpoint was the composite of mortality and readmission at 1 year.
Results A total of 150 patients had NDD after TAVR and 210 patients had non-NDD. Mean age and the Society of Thoracic Surgeons Predicted Risk of Mortality were 80.7 ± 8.8 years and 6.6 ± 3.7%, respectively. Predictors of NDD were male sex (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.28 to 3.18), absence of atrial fibrillation (OR: 1.62; 95% CI: 1.02 to 2.57), serum creatinine (OR: 0.71; 95% CI: 0.55 to 0.92), and age (OR: 0.95; 95% CI: 0.93 to 0.98). As expected, 84% of patients with complications had non-NDD. After excluding cases with complications, there was no difference in hazard rates of the 30-day composite outcome between NDD and non-NDD (hazard ratio: 0.62; 95% CI: 0.20 to 1.91), but the hazard of the composite outcome at 1 year was significantly lower in the NDD group (hazard ratio: 0.47; 95% CI: 0.27 to 0.81). This difference in the composite outcome can be explained by the lower hazard of noncardiovascular related readmission in the NDD group.
Conclusions Factors predicting NDD include male sex, absence of atrial fibrillation, lower serum creatinine, and younger age. When compared with patients without complications with a longer hospital stay, NDD appears to be safe, achieving similar 30-day and superior 1-year clinical outcomes.
Dr. Keegan has served as a consultant for Edwards Lifesciences and Abbott Vascular. Dr. Lerakis is a consultant for and has received research grant support from Abbott Vascular and Edwards Lifesciences. Ms. Simone has served as a speaker for Edwards Lifesciences. Dr. Leshnower has served on the speakers bureau for Medtronic. Dr. Devireddy has served on the scientific advisory board for Medtronic. Dr. Guyton has served as the national principal investigator on the Edwards Lifesciences TMVR early feasibility trial. Dr. Thourani has served as a consultant for Edwards Lifesciences, Abbott Vascular, Gore Vascular, and Boston Scientific. Dr. Babaliaros is a consultant for and has received research grant support from Abbott Vascular and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2017.
- Revision received October 11, 2017.
- Accepted October 17, 2017.