Late outcomes of early discharge following transcatheter aortic valve implantation: results from the POLESTAR trial

Background Early discharge (ED) within 48 h after transcatheter aortic valve implantation (TAVI) seems feasible and safe. The POLESTAR study demonstrated good 30-day outcomes of ED after TAVI using the ACURATE valve but also identified patients requiring prolonged hospitalization. Long-term outcomes after ED or prolonged hospitalization remain unknown. Aims To determine the long-term impact of successful ED and prolonged hospitalization. Methods POLESTAR was a prospective, multicentre, observational trial enrolling patients deemed eligible for ED prior to transfemoral TAVI with ACURATE Neo/Neo2. One-year outcomes were determined and compared between those who achieved ED and those who did not. The primary endpoint was a landmark analysis of major adverse cardiovascular events (MACE), including all-cause mortality, stroke, myocardial infarction, and cardiac rehospitalization, occurring between 30 days and oneyear post-procedure. Results Among 252 patients from 15 sites in four countries, ED was achieved in 173 (69%) patients, while 79 (31%) required prolonged hospital stay (non-ED). One-year survival was 97%. Landmark 30-day analysis showed MACE occurring in 4.7% of ED patients vs 11.7% of non-ED patients at 1 year (HR 0.38[0.15–0.98] P = .045). Rehospitalization was numerically lower in the ED group (HR 0.56[0.27–1.19]; P = .13). Kansas City Cardiomyopathy Questionnaire (KCCQ) scores improved significantly in the full cohort (18.5 improvement; 95%CI: 15.9–21.0, P < .01), with no statistically significant difference between ED and non-ED cohorts (P for interaction = .30). Conclusions An ED strategy after TAVI with ACURATE Neo was safe in selected patients without compromising longer-term outcomes or health-related quality of life. Patients who did not achieve ED experienced more MACE after 30 days (NCT03910751).