Same-Day Discharge Post-Transcatheter Aortic Valve Replacement During the COVID-19 Pandemic: The Multicenter PROTECT TAVR Study.

OBJECTIVES

The aim of this study was to determine the safety and efficacy of same-day discharge (SDD) after transcatheter aortic valve replacement (TAVR) during the COVID-19 pandemic.

BACKGROUND

The COVID-19 pandemic has placed significant stress on health care systems worldwide. SDD in highly selected TAVR patients can facilitate the provision of essential cardiovascular care while managing competing COVID-19 resource demands.

METHODS

Patient selection for SDD was at the discretion of the local multidisciplinary heart team, across 7 international sites. The primary outcome was a composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new permanent pacemaker (PPM) implantation.

RESULTS

From March 2020 to August 2021, 124 of 2,100 patients who underwent elective transfemoral TAVR were selected for SDD. The average age was 78.9 ± 7.8 years, the median Society of Thoracic Surgeons score was 2.4 (IQR: 1.4-4.2), and 32.3% (n = 40) had preexisting PPMs. There were no major vascular complications, strokes, or deaths during the index admission. One patient (0.8%) required PPM implantation for complete heart block and was discharged the same day. No patient required a PPM between discharge home and 30-day follow-up. The composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new PPM at 30 days occurred in 5.7% patients (n = 6 of 106).

CONCLUSIONS

SDD post-TAVR is safe and feasible in selected patients at low risk for adverse clinical events postdischarge. This strategy may have a potential role in highly selected patients even when the COVID-19 pandemic abates.

Informations de copyright

Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Sathananthan is a consultant to Edwards Lifesciences and Medtronic; and has received speaker fees from Edwards Lifesciences and NVT. Dr Devireddy has received consulting fees from Edwards Lifesciences, Medtronic, ReCor Medical, and Shockwave Medical. Ms Keegan is a consultant for Edwards Lifesciences, Medtronic, and Abbott Vascular. Dr Grubb is a speaker, proctor, and principal investigator for Edwards Lifesciences and Medtronic; and receives grants and educational funding to her employer from Edwards Lifesciences and Medtronic. Dr Spence has received consulting fees and/or institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Muir is a proctor for Edwards Lifesciences and Abbott Vascular; and has received departmental grants from Edwards Lifesciences and Abbott Vascular. Dr Russo is a speaker, proctor, and principal investigator for Edwards Lifesciences; and receives research funding to his employer from Edwards Lifesciences. Dr Pineda-Salazar receives research funding to her employer from Edwards Lifesciences. Ms Smith has received research funding to her employer from Edwards Lifesciences. Dr Dahle is a speaker, proctor, and principal investigator for Edwards Lifesciences and Medtronic. Dr Meier is supported by the Swiss National Science Foundation (grant P2LAP3_199561). Dr Akodad has received research funding from Medtronic, Biotronik, and Fédération Française de Cardiologie. Dr Nestelberger has received research support from the Swiss National Science Foundation (P400PM_191037/1), the Swiss Heart Foundation (FF20079), the Prof Dr Max Cloëtta Foundation, Margarete und Walter Lichtenstein-Stiftung (3MS1038), the University of Basel, and the University Hospital Basel; and has received speaker honoraria and consulting honoraria from Siemens, Beckman Coulter, Bayer, Ortho Clinical Diagnostics, and Orion. Dr Lauck is a consultant to Edwards Lifesciences. Dr Webb is a consultant to and receives unrestricted grant support from Medtronic, Edwards Lifesciences, and Abbott Vascular. Dr Wood has received consulting fees and/or institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.