Ariza-Solé Albert, Romaguera Rafael, Calvo Elena, Llaó Isaac, Muntané-Carol Guillem, Castillo-Poyo Rocío, Lorente Victòria, Poyo Rocío Castillo, Olivart David, Alegre Oriol, Domene Gerard, Gómez-Hospital Joan Antoni
Cardiology Department, Bellvitge University Hospital, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
J Geriatr Cardiol. 2025 May 28;22(5):506-515. doi: 10.26599/1671-5411.2025.05.002.
The number of transcatheter aortic valve implantation (TAVI) procedures in patients with severe aortic stenosis (AS) is increasing worldwide. We aimed to assess the impact of a TAVI program on clinical profile, management and outcomes of these patients and to describe predictors of length of hospital stay (LoS) in this context.
Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge (January 2018-December 2022). A TAVI program was implemented in may 2021. Baseline clinical characteristics, management and in-hospital complications were registered. Predictors of long hospital stay (> 7 day) were assessed by binary logistic regression.
We included 614 patients, with mean age 80.5 years. Most patients (438/614, 71.2%) presented conditions that precluded an early discharge. Mean hospital stay was 7.6 days. Patients admitted after the implementation of the program had a significantly lower burden of comorbidities. The rate of conduction disturbances after TAVI remained stable around 60%. However, permanent pacemaker requirement declined from 30.3% to 22.5% ( = 0.028). LoS was reduced after the implementation of the program both in patients suitable for an early discharge (from 6.5 day to 4 day, < 0.001) and unsuitable patients (from 9.4 day to 7.7 day, = 0.014). The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases, day of the week, emergent procedures, and conduction disturbances and other complications as independent predictors of long stay after TAVI.
Most patients undergoing TAVI present conditions that preclude an early hospital discharge. The implementation of a TAVI program improved selection of patients, with a lower burden of comorbidities, a lower rate of complications and a marked reduction of hospital stay.
在全球范围内，严重主动脉瓣狭窄（AS）患者接受经导管主动脉瓣植入术（TAVI）的数量正在增加。我们旨在评估TAVI项目对这些患者的临床特征、管理及预后的影响，并在此背景下描述住院时间（LoS）的预测因素。
一项回顾性单中心研究，纳入连续接受TAVI且存活至出院的AS患者（2018年1月至2022年12月）。2021年5月实施了TAVI项目。记录基线临床特征、管理情况及院内并发症。通过二元逻辑回归评估住院时间长（>7天）的预测因素。
我们纳入了614例患者，平均年龄80.5岁。大多数患者（438/614，71.2%）存在妨碍早期出院的情况。平均住院时间为7.6天。项目实施后入院的患者合并症负担明显更低。TAVI术后传导障碍发生率保持在60%左右稳定。然而，永久性起搏器需求率从30.3%降至22.5%（P = 0.028）。项目实施后，适合早期出院的患者住院时间缩短（从6.5天降至4天，P < 0.001），不适合早期出院的患者住院时间也缩短（从9.4天降至7.7天，P = 0.014）。LoS的最终预测模型包括既往起搏器使用情况和TAVI项目的可用性作为保护因素，以及其他瓣膜疾病、星期几、急诊手术、传导障碍和其他并发症作为TAVI后长期住院的独立预测因素。
大多数接受TAVI的患者存在妨碍早期出院的情况。TAVI项目的实施改善了患者选择，合并症负担更低，并发症发生率更低，住院时间显著缩短。
