Same Or Next-day Discharge After Transcatheter Aortic Valve Replacement
Alexis K. Okoh, Joshua Chao, Marlena E. Sabatino, Lauren A. Salgueiro, Cassandra Soto, Jigesh Baxi, Fady Soliman, Bruce Haik, Chunguang Chen, Leonard Y. Lee, Mark J. Russo
Robert Wood Johnson University Hospital, Department of Surgery, Division of Cardiothoracic Surgery; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
BACKGROUND: The advancement in Transcatheter Aortic Valve Replacement (TAVR) technology in recent years have given way to next-day discharge among a subset of patients. The present study aimed to assess clinical outcomes associated with same or next-day discharge post-TAVR. METHODS: Data on all patients who had TAVR at a high-volume center were reviewed retrospectively. Baseline demographics of patients who were discharged on the same or following day (SND) were compared to those who stayed in-hospital >1 day (>SND). Outcomes investigated were readmission, all-cause mortality and valve-function at 30-days and 1-year. Logistic regression was used to identify clinical predictors of SND. RESULTS: Out of 922 TAVR patients, 151(16%) were SND vs 771 (84%) (>SND). Compared to (>SND) patients, SND patients were younger (80 vs 82 years, p=0.036), had lower mean STS scores (5.6 vs 7.7, p<0.001), incidence of chronic lung disease (CLD) (12% vs 25%, p=0.002), and mostly underwent the procedure via a trans femoral approach (97% vs. 76%, p< 0.0001). Readmission rates were (2% vs 3%, p=0.481) in 30-days and (5% vs 12%, p=0.004) in 1-year for SND vs. (> SND) patients. After a mean follow up of 24 months, unadjusted all-cause mortality rates were (7% vs. 11%, p = 0.181) at 1-year and (8% vs 14%, p=0.072) in 2-years for SND and > SND patients respectively. At 1-year follow up valve function was satisfactory for both groups with a significant increase in mean aortic valve area (p< 0.001) and decrease in mean trans-aortic valvular gradients (p<0.001). Independent clinical factors that were associated with SND were younger age, male sex, TF approach, absence of baseline CLD or dialysis requirement and < moderate baseline mitral regurgitation. CONCLUSION: Same or next-day discharge is safe and feasible with satisfactory clinical outcomes in well selected patients undergoing TAVR. Re-admission and mortality rates in both 30-days and 1-year are not associated with SND post-TAVR.
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