Feasibility and Safety of Early Discharge After Transfemoral Transcatheter Aortic Valve Implantation With the Edwards SAPIEN-XT Prosthesis

Am J Cardiol. 2015 Apr 15;115(8):1116-22. doi: 10.1016/j.amjcard.2015.01.546. Epub 2015 Jan 31.

Abstract

There is currently no consensus on the duration of hospitalization required after transfemoral transcatheter aortic valve implantation (TAVI). We report the feasibility and safety of early discharge after TAVI with the Edwards SAPIEN-XT prosthesis. From 2009 to 2013, 337 patients underwent transfemoral TAVI with the Edwards SAPIEN-XT prosthesis using local anesthesia and were discharged home either early (≤3 days, Early Discharge group, n = 121) or after 3 days (Late Discharge group, n = 216). The primary end point of the study combined death and rehospitalization from discharge to 30-day follow-up. Patients in the Early Discharge group were less symptomatic (New York Heart Association class ≥III: 64.5% vs 75.5%, p = 0.01) and had less renal failure (creatinine: 102.1 ± 41.0 vs 113.3 ± 58.9 μmol/L, p = 0.04), atrial fibrillation (33.1% vs 46.3%, p = 0.02), and previous balloon aortic valvuloplasty (11.6% vs 23.1%, p = 0.01) and were more likely to have a pacemaker before TAVI (16.5% vs 8.3%, p = 0.02). Pre-existing pacemaker (p = 0.05) and the absence of acute kidney injury (p = 0.02) were independent predictors of an early discharge, whereas previous balloon aortic valvuloplasty (p = 0.03) and post-TAVI blood transfusions (p = 0.002) were independent predictors of late discharge. The primary end point occurred in 4 patients (3.3%) in the Early Discharge group and in 11 patients (5.1%) in the Late Discharge group (p = 0.58). In conclusion, the results of our study suggest that early discharge after transfemoral TAVI using the Edwards SAPIEN-XT prosthesis is feasible and safe in selected patients.

MeSH terms

  • Aged, 80 and over
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / surgery*
  • Cardiac Catheterization / methods*
  • Echocardiography
  • Electrocardiography
  • Feasibility Studies
  • Female
  • Femoral Artery
  • Follow-Up Studies
  • Heart Valve Prosthesis*
  • Humans
  • Length of Stay / trends
  • Male
  • Patient Discharge / trends*
  • Prosthesis Design
  • Retrospective Studies
  • Time Factors
  • Transcatheter Aortic Valve Replacement / methods*
  • Treatment Outcome