Early vs Standard Discharge After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis

Mamas

Abstract

Objectives: We sought to assess the clinical outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) with early discharge (ED) versus standard discharge (SD) pathways.

Background: Minimalist approaches for TAVI have been developed targeting different aspects of the procedure such as local anesthesia or sedation, intra-procedural imaging, vascular access, post-operative monitoring and care, and discharge planning. Their incorporation into routine clinical practice aim to reduce length of hospital stay (LoS) and healthcare cost utilisation without adversely affecting outcomes when compared to standard approaches.

Methods: We conducted a literature search of MEDLINE and EMBASE to identify studies that investigated ED (=3 days) versus SD in TAVI patients. Random-effects meta-analyses were used to estimate the effect of ED compared with SD with regards to 30-day mortality after discharge, 30-day re-admission rate and need for permanent pacemaker implantation (PPI) following discharge.

Results: Eight studies including 1,775 participants (ED n=642) fulfilled the inclusion criteria. The mean age was 82.4 years and Society of Thoracic Surgeons score was 6.7. Meta-analyses evaluating discharge to 30-day mortality (OR: 0.65, 95%CI 0.23-1.82, I2=0%) and discharge to 30-day new PPI (OR: 1.61, 95%CI 0.19-13.71, I2=40%) showed no significant difference of an ED compared to a SD strategy. Notably, ED patients were less likely to be re-admitted after ED when compared to SD patients (OR: 0.63, 95%CI 0.41-0.98, P=0.04, I2=0%).

Conclusion: ED following uncomplicated TAVI is safe in terms of discharge to 30-day mortality or need for PPI following discharge. Moreover, ED patients experienced a lower rate of re-admissions. These data support the safety of programs aiming an ED pathway in selected TAVI patients. Institutional protocols with the input from different members of the multi-disciplinary heart team should be devised to optimize discharge processes to improve healthcare resource utilisation.

Citation

Mamas. (2018). Early vs Standard Discharge After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis. JACC. Cardiovascular interventions, 1759-1771. https://doi.org/10.1016/j.jcin.2018.04.042

• Acceptance Date: May 1, 2018
• Publication Date: Sep 10, 2018
• Journal: JACC: Cardiovascular Interventions
• Print ISSN: 1876-7605
• Pages: 1759-1771
• DOI: https://doi.org/10.1016/j.jcin.2018.04.042
• Keywords: aortic stenosis; early discharge; readmission; TAVR; transcatheter
• Publisher URL: https://doi.org/10.1016/j.jcin.2018.04.042