title: A Prospective Analysis of Early Discharge After Transfemoral Transcatheter Aortic Valve Implantation.
abstract: As transcatheter aortic valve implantation (TAVI) becomes more routinely used, the recommended duration of monitoring after uncomplicated TAVI remains indeterminate. Retrospective analysis suggests that discharge within 72 hours is safe, but prospective data are largely lacking. We therefore prospectively assess the feasibility and safety of early discharge (within 72 hours) after transfemoral TAVI using Edwards SAPIEN-XT and SAPIEN-3 prostheses. Patients undergoing elective transfemoral TAVI were assessed prospectively for early discharge home. Feasibility and safety (death or repeat hospitalization within 30 days of discharge) of early discharge were assessed. Causes for failure of early discharge were assessed by prospective data collection and multivariate analysis. Of 130 patients, 76 (59%) were discharged early. Death or repeat hospitalization within 30 days occurred only in 4 cases (5%) among patients who discharged early: repeat hospitalization within 30 days was required in 3 early-discharge patients (4%), and there was a single death at 30 days. By multivariate analysis, factors associated with delayed discharge were blood transfusion (hazard ratio 13.85, 95% CI 1.61 to 119.40, p = 0.017) and pacemaker implantation (hazard ratio 4.47, 95% CI 1.34 to 14.26, p = 0.012). In conclusion, early discharge after elective transfemoral TAVI with SAPIEN-XT/SAPIEN-3 prostheses is safe and attainable in a large proportion of patients, with no evident compromise in safety. Factors associated with failure of early discharge are postprocedural blood transfusion and permanent pacemaker implantation.
authors.affiliation: Department of Cardiology, Rouen University Hospital, INSERM U 1096, Rouen, France; Division of Cardiology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Serletis-Bizios
authors.affiliation: Department of Cardiology, Rouen University Hospital, INSERM U 1096, Rouen, France. Electronic address: eric.durand@chu-rouen.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Durand
authors.affiliation: Department of Cardiology, Rouen University Hospital, INSERM U 1096, Rouen, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cellier
authors.affiliation: Department of Cardiology, Rouen University Hospital, INSERM U 1096, Rouen, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tron
authors.affiliation: Department of Cardiology, Rouen University Hospital, INSERM U 1096, Rouen, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bauer
authors.affiliation: Department of Cardiology, Rouen University Hospital, INSERM U 1096, Rouen, France.
authors.forename: Bastien
authors.initials: B
authors.lastname: Glinel
authors.affiliation: Department of Cardiology, Rouen University Hospital, INSERM U 1096, Rouen, France.
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Dacher
authors.affiliation: Department of Cardiology, Rouen University Hospital, INSERM U 1096, Rouen, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cribier
authors.affiliation: Department of Cardiology, Rouen University Hospital, INSERM U 1096, Rouen, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Eltchaninoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D005602:France; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D061214:Patient Safety; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement