González Raquel Pimienta, Fumero Alejandro Quijada, Villalba Marcos Farráis, González Javier Lorenzo, Carnicero Ana Laynez, Plasencia Alejandro Iriarte, Chiale Gabriela Noemí González, Ferraz Cristina López, Gómez Juan Manuel Llanos, Boto Martín Caicoya, Castillo Ángel López, Afonso Julio Salvador Hernández
Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España Servicio de Cardiología Hospital Universitario Nuestra Señora de Candelaria Santa Cruz de Tenerife España.
Servicio de Anestesiología y Reanimación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España Servicio de Anestesiología y Reanimación Hospital Universitario Nuestra Señora de Candelaria Santa Cruz de Tenerife España.
REC Interv Cardiol. 2025 Apr 29;7(3):146-153. doi: 10.24875/RECICE.M25000508. eCollection 2025.
Although early discharge protocols after transcatheter aortic valve implantation (TAVI) have demonstrated to be safe in various studies, they are usually applied in high-experience centers. This study analyzes the length of stay of the first 100 patients undergoing TAVI in a center without on-site cardiac surgery, differentiating between very early (< 24 hours), early (24-48 hours), and late discharge (> 48 hours). Furthermore, the study evaluates the feasibility of an early discharge protocol during the team's learning curve.
We conducted a prospective observational study from April 2022 through January 2024. A pre- and postoperative management protocol was implemented, including assessments in the Valvular Heart Disease Clinic, admission to the cardiac surgery intensive care unit with electrocardiographic monitoring, and specific discharge criteria in full compliance with an established protocol for the management of conduction disorders. Early follow-up evaluations were performed in the outpatiently after discharge.
A total of 100 patients (50% women) were included, with a mean age of 82.4 ± 5.3 years and a EuroSCORE II score of 4.38 ± 5.1%. The median length of stay was 2 days (range, 1-19). A total of 27.27% of patients were discharged in < 24 hours, 48.49% within the 24-48 hours following implantation, and 24.24% 48 hours later. The 30-day cardiovascular mortality rate was 1%. A total of 6 patients were readmitted with procedural complications within the first 30 days.
The implementation of a standardized care protocol allows for early and safe discharge in most patients, even during the team's learning cuve.
尽管经导管主动脉瓣植入术（TAVI）后的早期出院方案在多项研究中已证明是安全的，但这些方案通常应用于经验丰富的中心。本研究分析了在一个没有现场心脏外科手术的中心接受TAVI的前100例患者的住院时间，区分了极早期（<24小时）、早期（24 - 48小时）和晚期出院（>48小时）。此外，该研究评估了在团队学习曲线期间实施早期出院方案的可行性。
我们于2022年4月至2024年1月进行了一项前瞻性观察研究。实施了术前和术后管理方案，包括在心脏瓣膜病诊所进行评估、入住心脏外科重症监护病房并进行心电图监测，以及完全符合既定传导障碍管理方案的特定出院标准。出院后在门诊进行早期随访评估。
共纳入100例患者（50%为女性），平均年龄82.4±5.3岁，欧洲心脏手术风险评估系统（EuroSCORE）II评分为4.38±5.1%。中位住院时间为2天（范围1 - 19天）。27.27%的患者在<24小时内出院，48.49%在植入后24 - 48小时内出院，24.24%在48小时后出院。30天心血管死亡率为1%。共有6例患者在术后30天内因手术并发症再次入院。
实施标准化护理方案可使大多数患者早期安全出院，即使是在团队学习曲线期间。
