Ichibori Yasuhiro, Li Jun, Davis Angela, Patel Toral M, Lipinski Jerry, Panhwar Muhammad, Saric Petar, Qureshi Ghazanfar, Patel Sandeep M, Sareyyupoglu Basar, Markowitz Alan H, Bezerra Hiram G, Costa Marco A, Zidar David A, Kalra Ankur, Attizzani Guilherme F
Division of Cardiovascular Medicine University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106 USA.
J Invasive Cardiol. 2019 Mar;31(3):64-72. doi: 10.25270/jic/18.00300.
Data on next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR) are limited. This study investigated the feasibility and safety of NDD as a first-line option (the very-early discharge [VED] strategy) compared with the early-discharge (ED) strategy (2-3 days as a first-line option) after TAVR.
We reviewed 611 consecutive patients who had minimalist TAVR (transfemoral approach under conscious sedation) and no in-hospital mortality; a total of 418 patients underwent ED strategy (since December 2013) and 193 patients underwent VED strategy (as part of a hospital initiative to reduce length of stay, since August 2016). NDD in the VED strategy was performed with heart team consensus in patients without significant complications. The primary outcome was a composite of 30-day all-cause mortality/rehospitalization.
Sixty-five patients (33.7%) in the VED strategy and 10 patients (2.4%) in the ED strategy were discharged the next day (P<.001). NDD patients had received balloon-expandable (n = 30) or self-expanding valves (n = 45) and showed a similar primary outcome rate compared with non-NDD patients. After adjustment using propensity score matching (172 pairs), post-TAVR length of stay was significantly shorter in the VED group (3.2 ± 3.1 days) than in the ED group (3.5 ± 2.7 days; P<.01). The primary outcome did not differ between the two groups (7.0% vs 11.6%; P=.14), with comparable 30-day mortality rate (1.2% vs 2.3%; P=.68) and rehospitalization rate (5.8% vs 11.1%; P=.08).
Utilization of NDD as a first-line option after minimalist TAVR is feasible and safe, and leads to further reduction in length of stay compared with an ED strategy.
经导管主动脉瓣置换术（TAVR）后次日出院（NDD）的数据有限。本研究调查了与TAVR后早期出院（ED）策略（以2 - 3天作为一线选择）相比，NDD作为一线选择（极早期出院[VED]策略）的可行性和安全性。
我们回顾了611例连续接受简化TAVR（清醒镇静下经股动脉途径）且无院内死亡的患者；共有418例患者采用ED策略（自2013年12月起），193例患者采用VED策略（作为医院缩短住院时间倡议的一部分，自2016年8月起）。VED策略中的NDD在无严重并发症的患者中经心脏团队共识实施。主要结局是30天全因死亡率/再住院率的复合指标。
VED策略组中有65例患者（33.7%）次日出院，ED策略组中有10例患者（2.4%）次日出院（P <.001）。NDD患者接受了球囊扩张式瓣膜（n = 30）或自膨胀瓣膜（n = 45），与非NDD患者相比，主要结局发生率相似。使用倾向评分匹配（172对）进行调整后，VED组TAVR后的住院时间（3.2±3.1天）显著短于ED组（3.5±2.7天；P <.01）。两组的主要结局无差异（7.0%对11.6%；P =.14），30天死亡率（1.2%对2.3%；P =.68）和再住院率（5.8%对11.1%；P =.08）相当。
在简化TAVR后将NDD作为一线选择是可行且安全的，与ED策略相比可进一步缩短住院时间。
