The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Predictors and Safety of Next-Day Discharge in Unselected Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation

DOI: 10.4244/EIJ-D-19-01080

1. Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Catania, Italy
2. Division of Cardiology, Poliiclinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy, ITALY
3. Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy
4. Division of Cardiac Surgery, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy
5. Division of Radiology, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., Catania, Italy
6. Division of Vascular Surgery, Policlinico-Vittorio Emanuele Hospital, C.A.S.T., University of Catania, Catania, Italy
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Aim: To evaluate predictors and safety of next-day discharge (NDD) after transfemoral transcatheter aortic valve implantation (TF-TAVI) in unselected patients receiving either balloon- or self-expanding devices.

Methods and results: From June 2007 to August 2018, 1,232 consecutive patients undergoing TF-TAVI were discharged alive from our Institution. They had a mean age of 80.95.4 years and an intermediate estimated surgical mortality risk, and received either balloon-(26.1%) or self-expanding prostheses (73.9%). We compared patients discharged within 24 hours from the procedure (n=160,13.0%) with those discharged later, and accounted for confounding variables through a propensity matching adjustment.

After adjustment, no differences in all-cause mortality (1.2% vs. 0.0%, for NDD and no-NDD matched groups respectively, p=0.16) and permanent pacemaker implantation (PPI) after TAVI (0.6% vs. 0.6%) were encountered at 30 days. At 1 year, no difference in composite endpoint of all-cause death and heart failure (HF) rehospitalization was encountered (KM estimates 91.9% vs. 90.6% for NDD and no-NDD matched groups respectively, p=0.69). After excluding patients with post-procedural major complications from the unmatched population, prior PPI (OR:2.06; 95% CI:1.21-3.51; p<0.01) and availability of pre-procedural computed tomography angiography (CTA) (OR:1.71; CI:1.15-2.54; p<0.01) were found to be predictors of NDD after TAVI.

Conclusions: NDD in unselected patients after TF-TAVI using either balloon- or self-expanding devices demonstrated to be a safe strategy up to 1 year in absence of procedural complications. Patients with prior PPI and undergoing pre-procedural CTA had a higher chance of NDD.

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