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Original article
Early discharge after transfemoral transcatheter aortic valve implantation
  1. Marco Barbanti1,
  2. Piera Capranzano1,
  3. Yohei Ohno1,
  4. Guilherme F Attizzani1,
  5. Simona Gulino1,
  6. Sebastiano Immè1,
  7. Stefano Cannata1,
  8. Patrizia Aruta1,
  9. Vera Bottari1,
  10. Martina Patanè1,
  11. Claudia Tamburino1,
  12. Daniele Di Stefano1,
  13. Wanda Deste1,
  14. Daniela Giannazzo1,
  15. Giuseppe Gargiulo1,
  16. Giuseppe Caruso1,
  17. Carmelo Sgroi1,
  18. Denise Todaro1,
  19. Emanuela di Simone1,
  20. Davide Capodanno1,
  21. Corrado Tamburino1,2
  1. 1Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
  2. 2ETNA Foundation, Catania, Italy
  1. Correspondence to Dr Marco Barbanti, Division of Cardiology, Ferrarotto Hospital, University of Catania, Via Citelli 1, Catania 95100, Italy; mbarbanti83{at}gmail.com

Abstract

Background The aim of this study was to assess the feasibility and the safety of early discharge (within 72 h) after transfemoral transcatheter aortic valve implantation (TAVI) and to identify baseline features and/or peri-procedural variables, which may affect post-TAVI length-of-stay (LoS) duration.

Methods and results Patients discharged within 72 h of TAVI (early discharge group) were compared with consecutive patients discharged after 3 days (late discharge group). Propensity-matched cohorts of patients with a 2:1 ratio were created to better control confounding bias. Among 465 patients, 107 (23.0%) were discharged within 3 days of the procedure. Multivariable regression analysis of unmatched patients demonstrated that baseline New York Heart Association (NYHA) class IV (OR: 0.22, 95% CI 0.05 to 0.96; p=0.045) and any bleeding (OR: 0.31, 95% CI 0.74 to 0.92; p=0.031) were less likely to be associated with early discharge after TAVI. Conversely, the year of procedure (OR: 1.66, 95% CI 1.25 to 2.20; p<0.001) and the presence of a permanent pacemaker (PPM) before TAVI (OR: 2.80, 95% CI 1.36 to 5.75; p=0.005) were associated with a higher probability of early discharge. In matched populations, patients in the early discharge group reported lower incidence of in-hospital bleeding (7.9% vs 19.4%, p=0.014), major vascular complications (2.3% vs 9.1%, p=0.038) and PPM implantation (7.9% vs18.5%, p=0.021), whereas after discharge, at 30-day, no significant differences were reported between groups in terms of death (2.2% vs 1.7%, p=0.540), bleeding (0.0% vs 1.1%, p=0.444), PPM implantation (1.1% vs 0.0%, p=0.333) and re-hospitalisation (1.1% vs 1.1%, p=1.000).

Conclusions Early discharge (within 72 h) after transfemoral TAVI is feasible and does not seem to jeopardise the early safety of the procedure, when performed in a subset of patients selected by clinical judgement. Patients undergoing TAVI in unstable haemodynamic compensation and patients experiencing bleeding after the procedure demonstrated to be poorly suitable to this approach, whereas increasing experience in post-TAVI management was associated with a reduction of LoS.

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