title: Early discharge after transfemoral transcatheter aortic valve implantation.
abstract: BACKGROUND
  The aim of this study was to assess the feasibility and the safety of early discharge (within 72 h) after transfemoral transcatheter aortic valve implantation (TAVI) and to identify baseline features and/or peri-procedural variables, which may affect post-TAVI length-of-stay (LoS) duration.
  
  
  RESULTS
  Patients discharged within 72 h of TAVI (early discharge group) were compared with consecutive patients discharged after 3 days (late discharge group). Propensity-matched cohorts of patients with a 2:1 ratio were created to better control confounding bias. Among 465 patients, 107 (23.0%) were discharged within 3 days of the procedure. Multivariable regression analysis of unmatched patients demonstrated that baseline New York Heart Association (NYHA) class IV (OR: 0.22, 95% CI 0.05 to 0.96; p=0.045) and any bleeding (OR: 0.31, 95% CI 0.74 to 0.92; p=0.031) were less likely to be associated with early discharge after TAVI. Conversely, the year of procedure (OR: 1.66, 95% CI 1.25 to 2.20; p<0.001) and the presence of a permanent pacemaker (PPM) before TAVI (OR: 2.80, 95% CI 1.36 to 5.75; p=0.005) were associated with a higher probability of early discharge. In matched populations, patients in the early discharge group reported lower incidence of in-hospital bleeding (7.9% vs 19.4%, p=0.014), major vascular complications (2.3% vs 9.1%, p=0.038) and PPM implantation (7.9% vs18.5%, p=0.021), whereas after discharge, at 30-day, no significant differences were reported between groups in terms of death (2.2% vs 1.7%, p=0.540), bleeding (0.0% vs 1.1%, p=0.444), PPM implantation (1.1% vs 0.0%, p=0.333) and re-hospitalisation (1.1% vs 1.1%, p=1.000).
  
  
  CONCLUSIONS
  Early discharge (within 72 h) after transfemoral TAVI is feasible and does not seem to jeopardise the early safety of the procedure, when performed in a subset of patients selected by clinical judgement. Patients undergoing TAVI in unstable haemodynamic compensation and patients experiencing bleeding after the procedure demonstrated to be poorly suitable to this approach, whereas increasing experience in post-TAVI management was associated with a reduction of LoS.
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Piera
authors.initials: P
authors.lastname: Capranzano
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Guilherme F
authors.initials: GF
authors.lastname: Attizzani
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Gulino
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Immè
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cannata
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Aruta
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Vera
authors.initials: V
authors.lastname: Bottari
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Patanè
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Di Stefano
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Wanda
authors.initials: W
authors.lastname: Deste
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Giannazzo
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gargiulo
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caruso
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Sgroi
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Denise
authors.initials: D
authors.lastname: Todaro
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: di Simone
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy ETNA Foundation, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D020379:Risk Adjustment; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data