Durand Eric, Beziau-Gasnier Delphine, Michel Morgane, Iung Bernard, Tchetche Didier, Bonnet Guillaume, Lhermusier Thibault, Gilard Martine, Souteyrand Geraud, Bouleti Claire, Ohlmann Patrick, Lefevre Thierry, Beygui Farzin, Chassaing Stephan, Chevreul Karine, Eltchaninoff Hélène
Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France.
Université Paris Cité, Paris, France.
Eur Heart J. 2024 Mar 14;45(11):952-962. doi: 10.1093/eurheartj/ehae081.
The length of stay (LOS) after transcatheter aortic valve implantation (TAVI) remains extremely variable whereas early discharge has been shown to be feasible and safe. The study objective was to evaluate the efficacy and safety of an intervention aimed at reducing LOS after transfemoral TAVI.
FAST-TAVI II is a prospective, multicentre, cluster, randomized, controlled study including patients with severe symptomatic aortic stenosis, who had transfemoral TAVI. The intervention consisted in a dedicated training programme to implement 10 quality of care measures to reduce LOS with an implementation phase of eight weeks. The primary endpoint was the proportion of patients discharged early within 3 days. Secondary endpoints included: LOS, 30-day mortality and 30-day incidence of readmission for cardiovascular events.
During the study period, 969 patients were enrolled in the intervention group and 860 patients in the control group. Mean age was 81.9 ± 6.6 years and mean EuroSCORE II was 4.4 ± 4.5%. Early discharge was achieved in 563 (58.1%) patients in the intervention group vs. 364 (42.3%) patients in the control group (P < .0001). Median LOS was significantly reduced in the intervention group compared to the control group [3 (IQR: 3) vs. 4 days (IQR: 3), P < .0001]. Thirty-day mortality was low and similar in the two groups (0.5% vs. 0.9%, P = .30), as were 30-day readmissions (4.6% vs. 2.8%, P = .28).
The intervention was simple and fast to implement, and was effective and safe to reduce LOS and increase the proportion of patients discharged early after TAVI (NCT04503655).
经导管主动脉瓣植入术（TAVI）后的住院时间（LOS）仍存在极大差异，而早期出院已被证明是可行且安全的。本研究的目的是评估一项旨在缩短经股动脉TAVI术后住院时间的干预措施的疗效和安全性。
FAST-TAVI II是一项前瞻性、多中心、整群、随机对照研究，纳入行经股动脉TAVI的重度症状性主动脉瓣狭窄患者。干预措施包括一个专门的培训项目，以实施10项护理质量措施来缩短住院时间，实施阶段为8周。主要终点是3天内早期出院的患者比例。次要终点包括：住院时间、30天死亡率和心血管事件30天再入院发生率。
在研究期间，干预组纳入969例患者，对照组纳入860例患者。平均年龄为81.9±6.6岁，平均欧洲心脏手术风险评估系统（EuroSCORE）II评分为4.4±4.5%。干预组563例（58.1%）患者实现了早期出院，而对照组为364例（42.3%）患者（P<.0001）。与对照组相比，干预组的中位住院时间显著缩短[3天（四分位间距：3） vs. 4天（四分位间距：3），P<.0001]。两组的30天死亡率均较低且相似（0.5% vs. 0.9%，P = .30），30天再入院率也相似（4.6% vs. 2.8%，P = .28）。
该干预措施实施简单快捷，对于缩短TAVI术后住院时间并提高早期出院患者比例是有效且安全的（临床试验注册号：NCT04503655）。
