Next-day discharge after TAVR is still safe when alternative access is required
Next-day discharge (NDD) is still a safe and effective treatment strategy when transcatheter aortic valve replacement (TAVR) procedures require alternative access, according to new research published in EuroIntervention.[1]
NDD is commonplace after transfemoral procedures, researchers noted, but some uncertainty remains when it comes to other vascular access strategies.
“Early discharge and NDD pathways following transfemoral TAVR have been gaining acceptance among heart teams,” wrote first author Yohanna John Zendo, MD, a researcher with London Health Sciences Centre in Ontario, Canada, and colleagues. “We recently demonstrated the safety and feasibility of NDD following TAVR with three different types of commercially available transcatheter heart valves. However, there is a lack of data on early discharge and NDD in patients undergoing TAVR using alternative access.”
Zendo et al. tracked data from patients treated at a high-volume facility. All TAVRs occurred from July 2018 to November 2024. The TAVR devices used for these procedures were developed by Medtronic, Boston Scientific or Edwards Lifesciences.
Overall, the study included 85 patients who underwent TAVR with alternative access. While 35 patients underwent transapical vascular access, another 29 underwent subclavian/axillary access and 21 underwent carotid access. These groups were all comparable in terms of preprocedural atrial fibrillation, right bundle branch block, left bundle branch block, left ventricular ejection fraction and aortic annulus perimeter. The mean age and mean Society of Thoracic Surgeons score for each group were 79.7 years old and 3.6 for transapical access patients, 81.4 years old and 3.7 for subclavian/axillary access patients, and 78.4 years old and 3.6 for carotid access patients.
While 38.9% of patients were treated with NDD, discharge after 48 hours was seen in 20% and discharge after 72 hours was seen in the remaining 41.1%. No significant differences were seen after 30 days between these groups. In addition, the study’s mortality rate was 0% after 30 days.
“The NDD/early discharge strategy was not associated with an increased risk of all-cause readmissions, cardiac and non-cardiac causes of readmission or deaths up to 30 days of follow-up,” the group wrote. “We also show the utilization of three different types of commercially available transcatheter heart valves used for TAVR using alternative access, representing a novel contribution to the current knowledge.”
The group did note that the small number of patients included in this study was a limitation. However, they also wrote that randomized controlled trials focused on this topic would prove to be challenging due to the fact that patients without periprocedural complications have no reason to be hospitalized for an extended period of time.
“Additionally, this study was carried out in a high-volume center of excellence for valvular heart disease treatment, where efficient bed turnover is essential for optimizing healthcare delivery,” the authors wrote.
Zendo and colleagues concluded that their 30-day data “support the expansion of NDD/early discharge pathways to be considered for all patients undergoing TAVR.”
Click here for the full study.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.