Schouten Diekje R, Heuver Josianne H, Stouten-Gresnigt Wendy, Weijers Paulien, van der Perk Esther, Soullié Michiel, Peper Joyce, Rensing Benno J M W, Ten Berg Jurriën M, Sonker Uday, Swaans Martin J, Timmers Leo
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Neth Heart J. 2025 Sep 4. doi: 10.1007/s12471-025-01986-9.
In recent years, hospital stays after transcatheter aortic valve replacement (TAVR) have shortened. Previous studies have shown that next-day discharge (NDD) is feasible without compromising patient safety, but data from the Dutch hospital setting are lacking. To assess the real-world effect of a NDD policy after TAVR.
A next-day discharge policy was introduced in 2022 at St. Antonius Hospital Nieuwegein, the Netherlands. We included elective TAVR patients between August 2022 and August 2024, excluding those with pre-existing hospitalisation, transapical access, or intraprocedural mortality.
Among 460 patients (mean age 80.1 ± 6.2 years, 40.9% female, and a median Edmonton Frail score of 3.0 [1.0-4.0]), the majority underwent transfemoral TAVR (99.1%), under local anaesthesia (97.0%), using self-expanding valves (78.3%). Patients in the NDD group were more often male, less frail, and less likely to have right bundle branch block before TAVR compared to delayed discharge (DD) patients. NDD was feasible in 269 patients (58.5%) with a low number of post-discharge complications at 30 days: 1.9% permanent pacemaker implantation and 2.2% minor vascular complications. There were no cases of mortality, major vascular complications, or in-hospital stroke. Main reasons for DD were conduction disorders, access site complications, and stroke, which contributed to a higher incidence of complications in the DD group (18.3% permanent pacemaker implantation, p < 0.001, 3.1% stroke, p = 0.004, 1.6% major vascular complication, overall p-value 0.02).
After implementing an NDD policy, 58.5% of patients were eligible for NDD after TAVR with a very low post-discharge complication rate.
近年来，经导管主动脉瓣置换术（TAVR）后的住院时间有所缩短。先前的研究表明，次日出院（NDD）在不影响患者安全的情况下是可行的，但荷兰医院环境的数据尚缺。为评估TAVR后NDD政策的实际效果。
2022年，荷兰奈沃海恩圣安东尼医院引入了次日出院政策。我们纳入了2022年8月至2024年8月期间接受择期TAVR的患者，排除那些既往有住院史、经心尖入路或术中死亡的患者。
在460例患者中（平均年龄80.1±6.2岁，40.9%为女性，埃德蒙顿衰弱评分中位数为3.0[1.0 - 4.0]），大多数患者接受经股动脉TAVR（99.1%），在局部麻醉下进行（97.0%），使用自膨胀瓣膜（78.3%）。与延迟出院（DD）患者相比，NDD组患者男性更多、身体更不虚弱，且在TAVR前发生右束支传导阻滞的可能性更小。269例患者（58.5%）可行NDD，30天时出院后并发症数量较少：1.9%植入永久性起搏器，2.2%发生轻微血管并发症。无死亡、重大血管并发症或院内卒中病例。DD的主要原因是传导障碍、穿刺部位并发症和卒中，这导致DD组并发症发生率更高（18.3%植入永久性起搏器，p<0.001；3.1%发生卒中，p = 0.004；1.6%发生重大血管并发症，总体p值为0.02）。
实施NDD政策后，58.5%的患者在TAVR后符合NDD条件，出院后并发症发生率极低。
