Alkhalil Ahmad, Lamba Harveen, Deo Salil, Bezerra Hiram G, Patel Sandeep M, Markowitz Alan, Simon Daniel I, Costa Marco A, Davis Angela C, Attizzani Guilherme F
Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Catheter Cardiovasc Interv. 2018 Feb 1;91(2):345-353. doi: 10.1002/ccd.27230. Epub 2017 Aug 24.
Determine the feasibility and predictors of early discharge after minimalist transcatheter aortic valve replacement (TAVR).
Duration of hospitalization has a direct impact on overall cost of care, but the clinical impact of length of stay (LOS) in patients undergoing minimalist TAVR remains unclear.
We studied 268 patients who underwent minimalist TAVR. Short LOS (sLOS) was defined as post-procedural LOS ≤ 3 days and observed in 163 patients. Prolonged LOS (pLOS) was observed in 105 patients. Propensity score matching based on 39 variables yielded 54 pairs of patients in each group. We analyzed 30-day mortality, 30-day re-hospitalization and long-term survival data. Multivariate regression models were used to define predictors of sLOS.
Thirty-day mortality was 0% versus 5.5% in the sLOS and pLOS groups, respectively (P = 0.08). Incidence of re-hospitalization was higher in pLOS (13% vs. 3.7%). sLOS was associated with lower odds ratio of minor vascular complication (OR 0.1 [95% CI: 0.01, 0.75], P = 0.05), any bleeding (OR 0.35 [95% CI: 0.14, 0.87], P = 0.02), blood transfusion (OR 0.27 [95% CI: 0.08, 0.81], P = 0.02), and new pacemaker implantation (OR 0.23 [95% CI: 0.1, 0.53], P < 0.001). Discharge to home had a significantly higher odd ratio for sLOS (OR 8.67 [95% CI: 3.59, 23.11], P < 0.001).
In appropriately selected patients, sLOS following minimalist TAVR approach in an experienced and high volume center is feasible and safe. Implementing such a strategy may reduce medical costs with the potential clinical benefit of early re-habilitation for the elderly TAVR population.
确定简化经导管主动脉瓣置换术（TAVR）后早期出院的可行性及预测因素。
住院时间对总体医疗费用有直接影响，但简化TAVR患者的住院时长（LOS）的临床影响仍不明确。
我们研究了268例行简化TAVR的患者。短住院时长（sLOS）定义为术后LOS≤3天，163例患者观察到该情况。105例患者观察到长住院时长（pLOS）。基于39个变量进行倾向评分匹配，每组产生54对患者。我们分析了30天死亡率、30天再住院率及长期生存数据。采用多因素回归模型确定sLOS的预测因素。
sLOS组和pLOS组的30天死亡率分别为0%和5.5%（P = 0.08）。pLOS组的再住院发生率更高（13%对3.7%）。sLOS与较低的轻微血管并发症比值比相关（OR 0.1[95%CI：0.01，0.75]，P = 0.05）、任何出血（OR 0.35[95%CI：0.14，0.87]，P = 0.02）、输血（OR 0.27[95%CI：0.08，0.81]，P = 0.02）及新起搏器植入（OR 0.23[95%CI：0.1，0.53]，P < 0.001）。出院回家的sLOS比值比显著更高（OR 8.67[95%CI：3.59，23.11]，P < 0.001）。
在经验丰富且手术量大的中心，对适当选择的患者采用简化TAVR方法后的sLOS是可行且安全的。实施该策略可能降低医疗成本，并为老年TAVR人群带来早期康复的潜在临床益处。
