Pop Andrei M, Barker Madeleine, Hickman Lynn, Barrow Firas, Sathananthan Janarthanan, Stansfield William, Nikolov Michael, Mohamed Elsayed, Lauck Sandra, Wang Jia, Webb John G, Wood David A
Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA.
Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
Struct Heart. 2021 Jun;5(6):596-604. doi: 10.1080/24748706.2021.1988780. Epub 2022 Mar 21.
Transcatheter aortic valve replacement (TAVR) with a standardized clinical pathway allows most patients to achieve safe next-day discharge. This approach has been successfully implemented across global centers as part of the Benchmark Program. Considering restricted hospital resources resulting from the COVID-19 pandemic, a modified same day discharge (SDD) clinical pathway was implemented for selected TAVR patients at a single Benchmark site.
All patients accepted for TAVR were assessed for the SDD clinical pathway. Eligibility criteria included adequate social support and accessibility to the TAVR program post-discharge. Patients with preexisting conduction disease were excluded. The clinical pathway comprised of mobilization, bloodwork and electrocardiogram 4 hours post-TAVR and discharge ≥8 hours following groin hemostasis.
From June to December 2020, 142 patients underwent TAVR at a single community Benchmark site. Of those, 29 highly selected patients were successfully discharged the same day using the SDD clinical pathway. There were no vascular access complications, permanent pacemaker (PPM) implantation, or mortality in the SDD group during index admission or at 30-day follow-up. When compared to a standard therapy group, there was no statistically significant difference in 30-day cardiovascular readmission.
This study demonstrates the safety and feasibility of same day discharge post-TAVR in a highly selected cohort of patients, with no observable difference in safety outcomes when compared to patients who were discharged according to standard institutional practice. AS: aortic stenosis; ACT: Activated clotting time; AV: atrioventricular; AVB: atrioventricular block; BBB: bundle branch block; CAIC: Canadian Society for Cardiovascular Angiography; CCL: cardiac catheterization laboratory; CT: Computed topography; CV: cardiovascular; IQR: Interquartile Range; IVCD: intraventricular conduction delay; LBBB: left bundle branch block; LOS: length of stay; NDD: next day discharge; PPM: permanent pacemaker; RBBB: right bundle branch block; SCAI: Society for Cardiovascular Angiography and Intervention; SD: standard deviation; SDD: same day discharge; ST: standard therapy; STS PROM: society of thoracic surgeons predicted risk of mortality; TAVR: transcatheter aortic valve replacement; TF: transfemoral; THV: transcatheter heart valve; TTE: transthoracic echocardiogram; VARC: Valve Academic Research Consortium.
采用标准化临床路径的经导管主动脉瓣置换术（TAVR）可使大多数患者实现安全的次日出院。作为基准项目的一部分，这种方法已在全球各中心成功实施。考虑到2019冠状病毒病大流行导致医院资源受限，在一个基准站点对选定的TAVR患者实施了改良的当日出院（SDD）临床路径。
对所有接受TAVR的患者进行SDD临床路径评估。入选标准包括有足够的社会支持以及出院后可接入TAVR项目。排除既往有传导疾病的患者。临床路径包括TAVR术后4小时的活动、血液检查和心电图检查，以及腹股沟止血后≥8小时出院。
2020年6月至12月，142例患者在一个社区基准站点接受了TAVR。其中，29例经过严格筛选的患者通过SDD临床路径于当日成功出院。SDD组在首次住院期间或30天随访时未出现血管通路并发症、永久性起搏器（PPM）植入或死亡情况。与标准治疗组相比，30天心血管再入院率无统计学显著差异。
本研究证明了在经过严格筛选的患者队列中TAVR术后当日出院的安全性和可行性，与按照标准机构实践出院的患者相比，安全结果无明显差异。AS：主动脉瓣狭窄；ACT：活化凝血时间；AV：房室；AVB：房室传导阻滞；BBB：束支传导阻滞；CAIC：加拿大心血管造影学会；CCL：心导管实验室；CT：计算机断层扫描；CV：心血管；IQR：四分位间距；IVCD：室内传导延迟；LBBB：左束支传导阻滞；LOS：住院时间；NDD：次日出院；PPM：永久性起搏器；RBBB：右束支传导阻滞；SCAI：心血管造影和介入学会；SD：标准差；SDD：当日出院；ST：标准治疗；STS PROM：胸外科医师协会预测的死亡风险；TAVR：经导管主动脉瓣置换术；TF：经股动脉；THV：经导管心脏瓣膜；TTE：经胸超声心动图；VARC：瓣膜学术研究联盟
