Same-day discharge after TAVR linked to positive outcomes
Same-day discharge (SDD) after transfemoral transcatheter aortic valve replacement (TAVR) is both safe and effective, according to a new meta-analysis published in the Canadian Journal of Cardiology.[1]
“In 2019, the number of TAVR procedures performed in the United States surpassed surgical aortic valve replacement,” wrote first author Princess Neila Litkouhi, BMed, MD, a researcher with The University of Sydney in Australia, and colleagues. “The prevalence of aortic stenosis is expected to more than double by 2050, thereby creating a need to streamline TAVR within existing resource constraints.”
While next-day discharge (NDD) after TAVR is already common, less is known about the safety and effectiveness of SDD. To learn more, Litkouhi et al. explored data from more than 3,5000 patients previously included in one of six different studies. While 9% of patients underwent SDD, the other 91% underwent NDD.
SDD patients had a mean age of 78.2 years old, and 59.3% were men. Balloon-expanding TAVR valves were used for 91.6% of cases, and self-expanding TAVR valves were used for the other 8.4%
Tracking 30-day outcomes
Overall, SDD was associated with lower rates of mortality, all-cause readmission, cardiovascular readmission and permanent pacemaker implantation after 30 days when compared to NDD patients. This is likely due to the fact that only low-risk patients were selected to potentially go home on the same day they underwent treatment. Even with this point in mind, however, the group said these findings suggest there are “no advantages in NDD over SDD” when considering treatment options for a low-risk patient undergoing an elective transfemoral TAVR procedure.
Stroke and major vascular complication rates, meanwhile, were comparable for the two patient groups. The authors emphasized how important it was to track such events when evaluating the potential impact of SDD.
“Stroke after TAVR most commonly occurs due to dislodgement and embolization of debris on the aortic valve apparatus or aortic arch,” they wrote. “The incidence peaks in the first four to six hours, after which it sharply declines. Vascular injury and bleeding rates have steadily declined with advancements in percutaneous closure devices, but are still among the most common major complications after TAVR.”
More data still needed on same-day discharge in patients with a self-expanding TAVR valve
One key takeaway from this meta-analysis was the lack of data on SDD in patients receiving a self-expanding TAVR valve. Prior studies, researchers explained, have primary focused on patients receiving balloon-expandable devices.
“Historically, self-expanding valves have had a higher documented incidence of post procedure conduction abnormalities, primarily due to greater oversizing relative to annular and left ventricular outflow tract anatomy, thus imparting greater radial force on the adjacent conduction pathway,” they wrote. “This perhaps explains the strong bias towards balloon-expandable valves among patients selected for SDD in the currently available studies … Newer-generation valves have been shown to have similar 30-day outcomes, including pacemaker rates, in patients undergoing NDD after transfemoral TAVR regardless of valve type. More studies are warranted evaluating SDD in self-expanding valves.”
‘A viable discharge option’
Overall, Litkouhi and colleagues concluded that SDD after elective transfemoral TAVR procedures “may be a viable discharge option in carefully selected patients.”
More research is still needed, however, including studies on patients with both balloon-expandable and self-expanding TAVR valves.
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.