Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada.
Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada.
Am J Cardiol. 2024 Sep 15;227:65-74. doi: 10.1016/j.amjcard.2024.07.005. Epub 2024 Jul 10.
Previous studies have shown the safety of early discharge pathways in selected patients and using selected transcatheter heart valves. Hence, we sought to evaluate the safety of next-day discharge (NDD) in patients who underwent transfemoral transcatheter aortic valve implantation (TF-TAVI) with the ACURATE neo/neo2 (Boston Scientific, Marlborough, Massachusetts) self-expanding aortic bioprosthesis. Patients who underwent TF-TAVI between January 2018 and April 2023 were prospectively included. Patients were stratified into 3 groups according to discharge times within 24 hours (NDD), between 24 and 48 hours, and those discharged >48 hours after TAVI. The primary outcome was the first unplanned readmission at 30 days after TAVI. Log-rank test was used to assess the differences in the outcome of interest between the groups. A total of 368 all-comers were included in this study. According to discharge times, 204 patients followed NDD, 69 patients 24 to 48 hours discharge, and 95 patients >48 hours discharge after TAVI. The mean age was 84 ± 6.3 years and 61% were women, without differences between the groups. The mean Society of Thoracic Surgeons score was lower in those with NDD versus 24 to 48 hours and >48 hours (2.9 ± 1.0, 3.2 ± 1.2, and 3.4 ± 1.4, respectively, p = 0.014). There were no differences between the groups in terms of preprocedural right bundle branch block or pacemaker. The need for new permanent pacemaker implantation was the leading postprocedural complication; it occurred more frequently in the >48 hours group than the 24 to 48 hours, and <24 hours groups (24% vs 8.6% and 2.2%, p <0.001). There were 5 strokes (1.4%) and all of them occurred in the >48 hours group (p = 0.005). At 30 days after discharge, there were no deaths and no differences in all-cause readmissions (9.3% in <24 hours, 8.6% in 24 to 48 hours, and 19% in >48 hours, log-rank p = 0.087). The readmission rates for new permanent pacemaker implantation requirement were 3.3% (n = 6) in NDD, 0% in 24 to 48 hours, and 1.6% (n = 5) in the >48 hours groups (p = 0.27). In conclusion, in unselected patients who underwent TF-TAVI with the ACURATE neo/neo2 self-expanding bioprosthesis, the NDD pathway is feasible and appears to be safe, without an increased risk of death or all-cause rehospitalization through 30 days after hospital discharge.
先前的研究表明，在选定的患者中使用选定的经导管心脏瓣膜可以安全地进行早期出院途径。因此，我们旨在评估在接受经股动脉经导管主动脉瓣植入术（TF-TAVI）的患者中进行次日出院（NDD）的安全性，使用的是 ACURATE neo/neo2（波士顿科学公司，马萨诸塞州马尔伯勒）自扩张主动脉生物瓣。2018 年 1 月至 2023 年 4 月期间，前瞻性纳入接受 TF-TAVI 的患者。根据 24 小时内（NDD）、24 至 48 小时内和 TAVI 后>48 小时内的出院时间，将患者分层为 3 组。主要结局是 TAVI 后 30 天内的首次非计划性再入院。对数秩检验用于评估各组之间感兴趣结局的差异。这项研究共纳入了 368 名所有患者。根据出院时间，204 名患者遵循 NDD，69 名患者出院时间为 24 至 48 小时，95 名患者出院时间>48 小时。平均年龄为 84±6.3 岁，61%为女性，各组之间无差异。在 NDD 与 24 至 48 小时和>48 小时之间，NDD 患者的平均胸外科医生协会评分较低（分别为 2.9±1.0、3.2±1.2 和 3.4±1.4，p=0.014）。术前右束支传导阻滞或起搏器在各组之间无差异。新植入永久性起搏器的需求是主要的术后并发症；在>48 小时组中比 24 至 48 小时和<24 小时组更常见（分别为 24%、8.6%和 2.2%，p<0.001）。有 5 例中风（1.4%），均发生在>48 小时组（p=0.005）。出院后 30 天，无死亡，全因再入院率无差异（<24 小时为 9.3%，24 至 48 小时为 8.6%，>48 小时为 19%，对数秩 p=0.087）。NDD 组中，需要植入新的永久性起搏器的再入院率为 3.3%（n=6），24 至 48 小时组为 0%，>48 小时组为 1.6%（n=5）（p=0.27）。总之，在接受 ACURATE neo/neo2 自扩张生物瓣的 TF-TAVI 的未经选择的患者中，NDD 途径是可行的，似乎是安全的，在出院后 30 天内，没有增加死亡或全因再入院的风险。
