Recent Studies Reveal Early Discharge Advantage following Successful Transfemoral TAVR Procedure

Reduced Hospitalization Proves Particularly Beneficial During COVID-19 Era, though Caution Needed for Certain Patient Groups

Two recent studies observing patients undergoing a transfemoral transcatheter aortic valve replacement (TAVR) procedure have reported shorter hospital stays with no adverse impact on outcomes among study patients – a particular benefit in the COVID-19 era.Transcatheter Aortic Valve Replacement

One study, conducted by researchers from Policlnico-Vittorio Emanuele Hospital, University of Catania, Italy and published in EuroIntervention, found that “discharging patients within 24 hours of a transfemoral TAVR procedure performed without complications appears to be a safe approach,” which could have implications for patient care in the COVID-19 era.1

The researchers reported that “there were no differences in rates of mortality or rehospitalization for heart failure through the first year between patients discharged the next day and those who left the hospital later” – noting that ‘patients with a prior permanent pacemaker implant (PPI) were more likely to receive next-day discharge.’

These results support broader efforts for a “minimalist approach” to post-procedure patient care in centers across the United States and abroad. Propelled by the pandemic, new protocols and best practices may emerge as a silver lining in otherwise challenging times.2

Conversely, a study published as a research letter November 9, 2020, in JACC: Cardiovascular Interventions, and presented at the virtual American Heart Association 2020 Scientific Sessions, reported that pacemaker implantation has risen slightly amid length of stay decline – suggesting that ‘the trend toward earlier discharge following TAVR means that some conduction disturbances are not picked up by physicians during the index stay and patients may develop complications outside the hospital.’3

While the percentage of pacemaker implantation procedures have remained within range, the early discharge of transfemoral TAVR patients changes the timing of implantation and readmission rates, as patients who may have required a pacemaker during their initial hospital stay are released, though later return for the procedure.

According to the study’s senior investigator, Anil Gehi MD of the University of North Carolina, “the need for pacemaker implantation has remained the same—it’s still in that 10% range—but what we saw was that there was a shift in the timing of pacemaker implantation.”

“Because patients are being discharged sooner, rather than getting their pacemaker during that initial hospitalization, more and more of them are having to come back for readmission and then getting their pacemaker,” said Gehi.

While researchers and practitioners agree shortened hospital stays can be beneficial to patient recovery, particularly during a pandemic, identifying high-risk patients for continued monitoring is key in shaping new protocols.

View video on the TAVR procedure.

References

  1. Costa G, Barbanti M, Picci A, et al. Predictors and safety of next-day discharge in patients undergoing transfemoral transcatheter aortic valve implantationEuroIntervention. 2020;16:e494-e501.
  2. Wood DA, Sathananthan J. “Minimalist” transcatheter aortic valve implantation during the COVID-19 pandemic: previously optional but now a necessityEuroIntervention. 2020;16:e451-e452.
  3. Mazzella AJ, Hendrickson MJ, Arora S, et al. Shifting trends in timing of pacemaker implantation after transcatheter aortic valve replacementJ Am Coll Cardiol Intv. 2020;Epub ahead of print.