Normandie University, UNIROUEN, INSERM U1096, Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France.
Rennes University, CHU de Rennes, INSERM LTSI U1099, 35000 Rennes, France.
Arch Cardiovasc Dis. 2020 Jun-Jul;113(6-7):391-400. doi: 10.1016/j.acvd.2019.11.010. Epub 2020 May 14.
Complications decrease after transfemoral transcatheter aortic valve implantation (TAVI), and early discharge is feasible and safe in selected populations.
To evaluate length of stay (LOS) and reasons for prolonged hospitalisation after transfemoral TAVI in unselected patients.
Patients with severe aortic stenosis, who had transfemoral TAVI with the SAPIEN 3 prosthesis using exclusively local anaesthesia, were prospectively and consecutively included at five French high-volume centres. LOS was calculated from TAVI procedure to discharge. Reasons for prolonged hospitalisation (i.e.>3 days) were evaluated.
Between 2017 and 2018, 293 patients were included, with a mean age of 82.4±6.5 years and a mean logistic EuroSCORE of 13.7±9.0%. The in-hospital mortality rate was 1.4%. The median LOS was 5 (3-7) days, and varied considerably between centres (from 2 to 7 days). Sixty-four (21.8%) patients were discharged within 3 days after transfemoral TAVI. Reported reasons for prolonged hospitalisation were complications in 62.2%, loss of autonomy in 3.1%, discharge refusal in 2.2% and logistical reasons in 0.9%. In 31.6% of cases, the investigators reported no apparent reasons.
The results of our study suggest that LOS after transfemoral TAVI, using the SAPIEN 3 prosthesis and a minimalist approach, varies considerably between centres. In almost a third of cases, hospitalisation was prolonged without any apparent reason. Efforts should be made to educate centres to reduce LOS.
经股动脉经导管主动脉瓣置换术（TAVI）后并发症减少，在选定的人群中，早期出院是可行且安全的。
评估经股动脉 TAVI 后未选择患者的住院时间（LOS）和延长住院时间的原因。
前瞻性连续纳入 2017 年至 2018 年在法国五家高容量中心接受经股动脉 TAVI 并单独使用局部麻醉的 SAPIEN 3 假体治疗的严重主动脉瓣狭窄患者。LOS 从 TAVI 手术到出院计算。评估延长住院时间（即>3 天）的原因。
共纳入 293 例患者，平均年龄为 82.4±6.5 岁，平均逻辑 EuroSCORE 为 13.7±9.0%。院内死亡率为 1.4%。中位 LOS 为 5（3-7）天，且各中心之间差异较大（2-7 天）。64（21.8%）例患者在经股动脉 TAVI 后 3 天内出院。延长住院时间的报告原因包括并发症 62.2%、自理能力丧失 3.1%、拒绝出院 2.2%和后勤原因 0.9%。在 31.6%的情况下，研究者报告没有明显的原因。
我们的研究结果表明，使用 SAPIEN 3 假体和极简主义方法进行经股动脉 TAVI 后，各中心之间的 LOS 差异很大。将近三分之一的情况下，住院时间延长而没有明显原因。应努力教育中心以缩短 LOS。
