FROM JACC: CARDIOVASCULAR INTERVENTIONS
Compared with a longer hospital stay, next-day discharge (NDD) after minimalist transcatheter aortic valve replacement (TAVR) appears safe, according to a recently reported analysis of patients treated at a single center.
The composite endpoint of mortality and readmission at 30 days was similar for NDD, compared with later discharges among patients who had a procedure that met minimalist criteria, defined in this study as transfemoral TAVR under conscious sedation and local anesthesia.
Mortality and readmission at 1 year was lower in the NDD group, mainly because of a lower risk of noncardiovascular readmissions, study authors reported in JACC: Cardiovascular Interventions . “Although superior NDD outcomes are likely attributed to selected patient characteristics, NDD in patients without in-hospital complications may be appropriate after transfemoral balloon-expandable TAVR,” wrote Norihiko Kamioka, MD, division of cardiology, Emory University, Atlanta, and associates.
The retrospective, observational analysis included 663 consecutive patients who underwent elective balloon-expandable TAVR during July 2014–July 2016. Cases with complications after the procedure were excluded.
The final analysis, which included 150 patients who had NDD and 210 discharged later, showed no difference between groups in the composite endpoint of mortality, and that 30-day readmissions were similar between groups (hazard ratio, 0.62; 95% confidence interval, 0.20-1.91).
Mortality and readmission at 1 year, the primary endpoint chosen for the study, favored the NDD group (HR, 0.47; 95% CI, 0.27-0.81), but “this finding probably reflects a healthier cohort in the NDD group,” the investigators noted. Furthermore, “although the reason for the discrepancy in the composite outcome at 1 year is mainly driven by noncardiovascular readmission, other confounding variables cannot be entirely ruled out,” Dr. Kamioka and colleagues said in the report.
Predictors of NDD included male sex, no atrial fibrillation, lower serum creatinine level, and younger age, researchers also found.
A validation cohort would be needed to confirm the findings of this study, including predictors of favorable outcomes, and to apply NDD to a wider population, study authors said.
Dr. Kamioka reported no relationships relevant to the study. Study coauthors reported disclosures related to Edwards Lifesciences, Abbott Vascular, Medtronic, Gore Vascular, and Boston Scientific.
SOURCE: JACC: Cardiovascular Interventions. 2018 Jan 22. doi: 10.1016/j.jcin.2017.10.021 .
