Streamlining postprocedural care after transcatheter edge-to-edge repair

BACKGROUND: Patients undergoing transcatheter edge-to-edge repair (TEER) of the mitral or tricuspid valve are predominantly elderly and exhibit high rates of frailty. The procedure regularly involves general anaesthesia, necessitating the monitoring of patients on an intensive or intermediate care unit (ICU/ImCU). This study aimed to investigate the outcome of patients being admitted to a general ward as opposed to an ICU/ImCU for postprocedural care after TEER. METHODS: This is a retrospective study analysing the course of 209 patients that underwent TEER at a university hospital centre in Germany from January 2022 to February 2024. Patients were assigned to either intended postprocedural care at ICU/ImCU (n = 113) or streamlined care (n = 95) based on a cut-off date unrelated to this study. RESULTS: In comparison to the ICU/ImCU group, patients in the streamlined group exhibited a significantly reduced total hospital stay (median 4 [IQR 3, 9] vs. 3 [IQR 3, 5] days, p = 0.009) and a reduced postprocedural length of stay without an elevated rate of unplanned ICU/ImCU admissions. Postprocedural care in the streamlined group was not associated with a higher rate of complications nor a higher mortality rate at 30 days (0.9% vs. 2.2%, p = 0.6), six months (10.1% vs. 4.7%, p = 0.2) or 12 months (16.0% vs. 12.0%, p = 0.4). CONCLUSIONS: The transition of postprocedural care from the ICU/ImCU to a general ward was found to be safe, reduced length of hospital stay and spared the utilization of ICU/ImCU resources. This encourages for randomised clinical trials to further advance the streamlined care of these patients.