Next-day discharge after TAVI was feasible, with cardiovascular events at 3 months occurring in 4.4% of successfully fast-tracked patients versus 11.4% in ineligible patients (P=0.06).
Cohort (n=479)
No
Does an early discharge ('fast track') protocol after TAVI maintain safety in patients with severe symptomatic aortic stenosis?
A fast-track next-day discharge protocol after TAVI is feasible and safe for the majority of eligible patients, with conduction disturbances and vascular complications being the primary barriers to early discharge.
Absolute Event Rate: 4.4% vs 11.4%
p-value: p=0.06
• FT is a feasible and safe approach after TAVI • The main causes of FT failure relate to rhythm disorders and vascular complications • A TAVI unit and coordinator standardize practices Background: Transcatheter aortic valve implantation is the standard treatment for symptomatic severe aortic stenosis. Advances in technology and minimally invasive techniques have made early discharge following transcatheter aortic valve implantation a feasible and safe option, optimizing hospital resource utilization without compromising care quality. Aim: To evaluate the feasibility and safety of early discharge ("fast track") following transcatheter aortic valve implantation in a single high-volume centre. Methods: This single-centre retrospective study included consecutive patients undergoing transcatheter aortic valve implantation (TAVI) for symptomatic severe aortic stenosis between April 2022 and Decembre 2023. Patients were stratified into FT– (ineligible), FT+/+ (next day discharge achieved), and FT+/– (early discharge failed) groups. The primary endpoint was a 3-month composite safety outcome. Results: Between April 2022 and December 2023, 506 patients aged > 18 years with severe symptomatic aortic stenosis underwent transcatheter aortic valve implantation at the University Hospital of Marseille Timone; of these, 479 patients were included in the analysis. Overall, 80.8% (n = 409; 95% confidence interval 77.2–84.0%) of the total patient population were eligible for fast track (FT+). The primary reason for ineligibility (FT–) was the presence of complete right bundle branch block (49.6%, n = 54; 95% confidence interval 40.1–59.2%). Among FT+ patients, 69.9% (n = 286; 95% confidence interval 65.3–74.1%) were discharged the next day (FT+/+); the early discharge strategy failed in 30.1% (n = 123) (FT+/–). Prolonged rhythm monitoring as a result of acquired conduction disorders delayed discharge in 55.9% (n = 76; 95% confidence interval 47.0–64.3%) of FT+/− cases. High-grade conduction disorders necessitated a mean wait of 4.1 days for pacemaker implantation. At 3-month follow-up, cardiovascular events occurred in 4.4% (n = 12/275) of FT+/+ patients, 6.9% (n = 8/116) of FT+/− patients and 11.4% (n = 10/88) of FT− patients (P = 0.06). Conclusions: Next-day discharge after transcatheter aortic valve implantation was feasible and safe for 69.9% of eligible patients (representing 56.5% of the overall cohort). Eligibility for the fast track protocol was achieved in 80.8% of patients. Conduction disturbances and vascular complications remain key obstacles leading to prolonged hospital stays and requiring optimization.
Rahmani et al. (Fri,) conducted a cohort in symptomatic severe aortic stenosis (n=479). Early discharge (fast track) protocol vs. Ineligible for fast track (FT-) was evaluated on 3-month composite safety outcome (cardiovascular events) (p=0.06). Next-day discharge after TAVI was feasible, with cardiovascular events at 3 months occurring in 4.4% of successfully fast-tracked patients versus 11.4% in ineligible patients (P=0.06).