Feasibility and safety of "fast-track” protocol after TAVI

• 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.