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Feasibility and Safety of Adopting Next-Day Discharge as First-Line Option After Transfemoral Transcatheter Aortic Valve Replacement.
- Source :
-
The Journal of invasive cardiology [J Invasive Cardiol] 2019 Mar; Vol. 31 (3), pp. 64-72. - Publication Year :
- 2019
-
Abstract
- Objectives: Data on next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR) are limited. This study investigated the feasibility and safety of NDD as a first-line option (the very-early discharge [VED] strategy) compared with the early-discharge (ED) strategy (2-3 days as a first-line option) after TAVR.<br />Methods: We reviewed 611 consecutive patients who had minimalist TAVR (transfemoral approach under conscious sedation) and no in-hospital mortality; a total of 418 patients underwent ED strategy (since December 2013) and 193 patients underwent VED strategy (as part of a hospital initiative to reduce length of stay, since August 2016). NDD in the VED strategy was performed with heart team consensus in patients without significant complications. The primary outcome was a composite of 30-day all-cause mortality/rehospitalization.<br />Results: Sixty-five patients (33.7%) in the VED strategy and 10 patients (2.4%) in the ED strategy were discharged the next day (P<.001). NDD patients had received balloon-expandable (n = 30) or self-expanding valves (n = 45) and showed a similar primary outcome rate compared with non-NDD patients. After adjustment using propensity score matching (172 pairs), post-TAVR length of stay was significantly shorter in the VED group (3.2 ± 3.1 days) than in the ED group (3.5 ± 2.7 days; P<.01). The primary outcome did not differ between the two groups (7.0% vs 11.6%; P=.14), with comparable 30-day mortality rate (1.2% vs 2.3%; P=.68) and rehospitalization rate (5.8% vs 11.1%; P=.08).<br />Conclusions: Utilization of NDD as a first-line option after minimalist TAVR is feasible and safe, and leads to further reduction in length of stay compared with an ED strategy.
- Subjects :
- Academic Medical Centers
Aged
Aged, 80 and over
Aortic Valve Stenosis diagnosis
Cohort Studies
Feasibility Studies
Female
Follow-Up Studies
Humans
Male
Ohio
Patient Discharge
Propensity Score
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Analysis
Time Factors
Transcatheter Aortic Valve Replacement mortality
United States
Aortic Valve Stenosis surgery
Length of Stay
Patient Readmission statistics & numerical data
Patient Safety
Transcatheter Aortic Valve Replacement methods
Subjects
Details
- Language :
- English
- ISSN :
- 1557-2501
- Volume :
- 31
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The Journal of invasive cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 30819977