Early discharge safe with minimal anesthesia, transfemoral TAVR

French researchers suggest that with the right transcatheter aortic valve, the right approach, local anesthesia and minimal complications, patients can be discharged early with no added risk.

Eric Durand, MD, PhD, of the cardiology department at the University Hospital of Rouen and the Hospital Charles Nicolle in Rouen, France, and colleagues used the Sapien-XT transcatheter aortic valve (Edwards Lifesciences). They enrolled 337 patients between 2009 and 2013 for transcatheter aortic valve replacements (TAVR) under local anesthesia and a transfemoral approach. After surgery, patients were either discharged in three days or less (early) or after three days (late).

Over time, rates for early discharge and mean length of stay increased and decreased, respectively and in parallel, increasing to 53.2 percent of patients discharged early and decreasing to a mean length of stay of five days by 2013.

They found that rates of death or rehospitalization at 30 days were lower among patients who were discharged early (3.3 percent vs. 5.1 percent). No patients who were discharged early died, however, 0.9 percent of patients in the late discharge group did.

While further analysis would need to occur to determine which patients were among the best candidates for early discharge, Durand et al did note a few predictors of early vs. late discharge. Patients with pre-existing pacemakers and no acute kidney injury were more likely to be discharged early. On the other hand, patients who had post-TAVR blood transfusions or previous balloon aortic valvuloplasty were more likely to be discharged late. None of the early discharge patients presented with delayed high degree atrioventricular block. One late discharged patient required a pacemaker following readmission for symptomatic bradycardia.

Durand et al noted that early discharge had a positive influence on patients, but also had the potential for having significant economic impact. This was particularly true with transfemoral access and early discharge, based on data from prior studies on increased life expectancy with TAVR and cost reduction using a minimalist strategy compared with surgical aortic valve replacement and conventional intervention strategies.

They suggested the key to best utilizing these results would be finding ideal patients. “A prospective ongoing study is therefore mandatory to confirm the feasibility and safety of early discharge after [TAVR] using the latest generation of balloon expandable Edwards’ prosthesis and to define the ideal candidates for that strategy,” Durand et al wrote.

The study was published online Jan. 31 in the American Journal of Cardiology.