Dion Stub, Rael Klein, Marco Barbanti, Julie E. Park, Ben Tyrell, Sandra Lauck, John G. Webb, Anson Cheung, Kevin Rondi, Jay Thakkar, Mark D. Peterson, John A. Cairns, Martin B. Leon, Richard C. Cook, Vinod H. Thourani, Karin H. Humphries, John Jue, Anita W. Asgar, Robert C. Welsh, Vasilis Babaliaros, Donald A. Palisaitis, Danny Dvir, Rohan Poulter, Philippe Généreux, Jean Bernard Masson, Kevin J Nickel, Madeleine Barker, Robert Moss, Harindra C. Wijeysundera, Tamin Nazif, Madhu K. Natarajan, James L. Velianou, David Cohen, Eric Horlick, Christopher E. Buller, Janarthanan Sathananthan, David A. Wood, Faisal Alqoofi, Philipp Blanke, Dale Murdoch, Mark Osten, Susheel Kodali, Hamed Umedaly, Sam Radhakrishnan, Jian Ye, Roshan Prakash, Jonathon Leipsic, Nay M. Htun, and Peter Fahmy
Objectives The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway. Background Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, hospital stays average at least 6 days in most trials. The Vancouver 3M Clinical Pathway is focused on next-day discharge, made possible by the use of objective screening criteria as well as streamlined peri- and post-procedural management guidelines. Methods Patients were enrolled from 6 low-volume ( 200 TAVR/year) centers in Canada and the United States. The primary outcomes were a composite of all-cause death or stroke by 30 days and the proportion of patients successfully discharged home the day following TAVR. Results Of 1,400 screened patients, 411 were enrolled at 13 centers and received a SAPIEN XT (58.2%) or SAPIEN 3 (41.8%) valve (Edwards Lifesciences, Irvine, California). In centers enrolling exclusively in the study, 55% of screened patients were enrolled. The median age was 84 years (interquartile range: 78 to 87 years) with a median STS score of 4.9% (interquartile range: 3.3% to 6.8%). Next-day discharge home was achieved in 80.1% of patients, and within 48 h in 89.5%. The composite of all-cause mortality or stroke by 30 days occurred in 2.9% (95% confidence interval: 1.7% to 5.1%), with neither component of the primary outcome affected by hospital TAVR volume (p = 0.51). Secondary outcomes at 30 days included major vascular complication 2.4% (n = 10), readmission 9.2% (n = 36), cardiac readmission 5.7% (n = 22), new permanent pacemaker 5.7% (n = 23), and >mild paravalvular regurgitation 3.8% (n = 15). Conclusions Adherence to the Vancouver 3M Clinical Pathway at low-, medium-, and high-volume TAVR centers allows next-day discharge home with excellent safety and efficacy outcomes.