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The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study

Authors :
David A, Wood
Sandra B, Lauck
John A, Cairns
Karin H, Humphries
Richard, Cook
Robert, Welsh
Jonathon, Leipsic
Philippe, Genereux
Robert, Moss
John, Jue
Philipp, Blanke
Anson, Cheung
Jian, Ye
Danny, Dvir
Hamed, Umedaly
Rael, Klein
Kevin, Rondi
Rohan, Poulter
Dion, Stub
Marco, Barbanti
Peter, Fahmy
Nay, Htun
Dale, Murdoch
Roshan, Prakash
Madeleine, Barker
Kevin, Nickel
Jay, Thakkar
Janarthanan, Sathananthan
Ben, Tyrell
Faisal, Al-Qoofi
James L, Velianou
Madhu K, Natarajan
Harindra C, Wijeysundera
Sam, Radhakrishnan
Eric, Horlick
Mark, Osten
Christopher, Buller
Mark, Peterson
Anita, Asgar
Donald, Palisaitis
Jean-Bernard, Masson
Susheel, Kodali
Tamim, Nazif
Vinod, Thourani
Vasilis C, Babaliaros
David J, Cohen
Julie E, Park
Martin B, Leon
John G, Webb
Source :
JACC. Cardiovascular interventions. 12(5)
Publication Year :
2018

Abstract

The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway.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.Patients were enrolled from 6 low-volume (100 TAVR/year), 4 medium-volume, and 3 high-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.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), andmild paravalvular regurgitation 3.8% (n = 15).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.

Details

ISSN :
18767605
Volume :
12
Issue :
5
Database :
OpenAIRE
Journal :
JACC. Cardiovascular interventions
Accession number :
edsair.pmid..........bb7da8e4e420f3b11ef931a4ddee8f51