title: Feasibility and Safety of Transcatheter Aortic Valve Implantation Performed Without Intensive Care Unit Admission.
abstract: Admission to the intensive care unit (ICU) is a standard of care after transcatheter aortic valve implantation (TAVI); however, the improvement of the procedure and the need to minimize the unnecessary use of medical resources call into question this strategy. We evaluated prospectively 177 consecutive patients who underwent TAVI. Low-risk patients, admitted to conventional cardiology units, had stable clinical state, transfemoral access, no right bundle branch block, permanent pacing with a self-expandable valve, and no complication occurring during the procedure. High-risk patients included all the others transferred to ICU. In-hospital events were the primary end point (Valve Academic Research Consortium 2 criteria). The mean age of patients was 83.5 ± 6.5 years, and the mean logistic EuroSCORE was 14.6 ± 9.7%. The balloon-expandable SAPIEN 3 valve was mainly used (n = 148; 83.6%), mostly with transfemoral access (n = 167; 94.4%). Among the 61 patients (34.5%) included in the low-risk group, only 1 (1.6%) had a minor complication (negative predictive value 98.4%, 95% confidence interval [CI] 0.91 to 0.99). Conversely, 31 patients (26.7%) from the high-risk group had clinical events (positive predictive value 26.7%, 95% CI 0.19 to 0.35), mainly conductive disorders requiring pacemaker (n = 26; 14.7%). In multivariate analysis, right bundle branch block (odds ratio [OR] 14.1, 95% CI 3.5 to 56.3), use of the self-expandable valve without a pacemaker (OR 5.5, 95% CI 2 to 16.3), vitamin K antagonist treatment (OR 3.8, 95% CI 1.1 to 12.6), and female gender (OR 2.6, 95% CI 1.003 to 6.9) were preprocedural predictive factors of adverse events. In conclusion, our results suggested that TAVI can be performed safely without ICU admission in selected patients. This strategy may optimize efficiency and cost-effectiveness of procedures.
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France. Electronic address: f-leclercq@chu-montpellier.fr.
authors.forename: Florence
authors.initials: F
authors.lastname: Leclercq
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Anais
authors.initials: A
authors.lastname: Iemmi
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lattuca
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Macia
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Gervasoni
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Roubille
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gandet
authors.affiliation: Department of Cardiology, University Hospital of Nîmes, Nîmes, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Schmutz
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Mariama
authors.initials: M
authors.lastname: Akodad
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Agullo
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Verges
authors.affiliation: Department of Medical Information, University Hospital of Montpellier, Montpellier, France.
authors.forename: Erika
authors.initials: E
authors.lastname: Nogue
authors.affiliation: Department of Medical Information, University Hospital of Montpellier, Montpellier, France.
authors.forename: Gregory
authors.initials: G
authors.lastname: Marin
authors.affiliation: Department of Medical Information, University Hospital of Montpellier, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nagot
authors.affiliation: Department of Cardiology, Clinique du Parc, Montpellier, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Rivalland
authors.affiliation: Department of Cardiology, Clinique des Franciscaines, Nîmes, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Durrleman
authors.affiliation: Department of Cardiology, Clinique St Pierre, Perpignan, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Robert
authors.affiliation: Department of Cardiology, General Hospital of Perpignan, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Delseny
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Albat
authors.affiliation: Department of Cardiology, University Hospital of Nîmes, Nîmes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003422:Critical Care; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome