Key result
A same day discharge pathway for highly selected TAVR patients yielded zero 30-day mortality or pacemaker implantations, with no significant difference in readmissions versus standard therapy.
Why the study?
Due to restricted hospital resources during the COVID-19 pandemic, a modified same day discharge pathway was implemented for selected TAVR patients.
Does a same day discharge clinical pathway safely prevent complications and readmissions compared to standard therapy in highly selected TAVR patients?
Cohort (n=142)
No
Does a same day discharge clinical pathway safely prevent complications and readmissions compared to standard therapy in highly selected TAVR patients?
A modified same-day discharge clinical pathway for highly selected TAVR patients without preexisting conduction disease appears safe and feasible, with no increase in 30-day cardiovascular readmissions or complications.
Same-day TAVR discharge may be feasible in selected patients during resource constraints; leaves open need for prospective trials before wider use.
Background: Transcatheter aortic valve replacement (TAVR) with a standardized clinical pathway allows most patients to achieve safe next-day discharge. This approach has been successfully implemented across global centers as part of the Benchmark Program. Considering restricted hospital resources resulting from the COVID-19 pandemic, a modified same day discharge (SDD) clinical pathway was implemented for selected TAVR patients at a single Benchmark site. Methods: All patients accepted for TAVR were assessed for the SDD clinical pathway. Eligibility criteria included adequate social support and accessibility to the TAVR program post-discharge. Patients with preexisting conduction disease were excluded. The clinical pathway comprised of mobilization, bloodwork and electrocardiogram 4 hours post-TAVR and discharge ≥8 hours following groin hemostasis. Results: From June to December 2020, 142 patients underwent TAVR at a single community Benchmark site. Of those, 29 highly selected patients were successfully discharged the same day using the SDD clinical pathway. There were no vascular access complications, permanent pacemaker (PPM) implantation, or mortality in the SDD group during index admission or at 30-day follow-up. When compared to a standard therapy group, there was no statistically significant difference in 30-day cardiovascular readmission. Conclusions: AS: aortic stenosis; ACT: Activated clotting time; AV: atrioventricular; AVB: atrioventricular block; BBB: bundle branch block; CAIC: Canadian Society for Cardiovascular Angiography; CCL: cardiac catheterization laboratory; CT: Computed topography; CV: cardiovascular; IQR: Interquartile Range; IVCD: intraventricular conduction delay; LBBB: left bundle branch block; LOS: length of stay; NDD: next day discharge; PPM: permanent pacemaker; RBBB: right bundle branch block; SCAI: Society for Cardiovascular Angiography and Intervention; SD: standard deviation; SDD: same day discharge; ST: standard therapy; STS PROM: society of thoracic surgeons predicted risk of mortality; TAVR: transcatheter aortic valve replacement; TF: transfemoral; THV: transcatheter heart valve; TTE: transthoracic echocardiogram; VARC: Valve Academic Research Consortium.
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Pop et al. (2021) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=142). Same day discharge (SDD) clinical pathway vs. Standard therapy was evaluated on 30-day cardiovascular readmission, vascular access complications, permanent pacemaker implantation, and mortality. A same day discharge pathway for highly selected TAVR patients yielded zero 30-day mortality or pacemaker implantations, with no significant difference in readmissions versus standard therapy.
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