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Safety of shorter length of hospital stay for patients undergoing minimalist transcatheter aortic valve replacement
Author(s) -
Alkhalil Ahmad,
Lamba Harveen,
Deo Salil,
Bezerra Hiram G.,
Patel Sandeep M.,
Markowitz Alan,
Simon Daniel I.,
Costa Marco A.,
Davis Angela C.,
Attizzani Guilherme F.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27230
Subject(s) - medicine , propensity score matching , odds ratio , complication , incidence (geometry) , valve replacement , cardiology , surgery , aortic valve replacement , stenosis , physics , optics
Objective Determine the feasibility and predictors of early discharge after minimalist transcatheter aortic valve replacement (TAVR). Background Duration of hospitalization has a direct impact on overall cost of care, but the clinical impact of length of stay (LOS) in patients undergoing minimalist TAVR remains unclear. Methods We studied 268 patients who underwent minimalist TAVR. Short LOS (sLOS) was defined as post‐procedural LOS ≤ 3 days and observed in 163 patients. Prolonged LOS (pLOS) was observed in 105 patients. Propensity score matching based on 39 variables yielded 54 pairs of patients in each group. We analyzed 30‐day mortality, 30‐day re‐hospitalization and long‐term survival data. Multivariate regression models were used to define predictors of sLOS. Results Thirty‐day mortality was 0% versus 5.5% in the sLOS and pLOS groups, respectively ( P = 0.08). Incidence of re‐hospitalization was higher in pLOS (13% vs. 3.7%). sLOS was associated with lower odds ratio of minor vascular complication (OR 0.1 [95% CI: 0.01, 0.75], P = 0.05), any bleeding (OR 0.35 [95% CI: 0.14, 0.87], P = 0.02), blood transfusion (OR 0.27 [95% CI: 0.08, 0.81], P = 0.02), and new pacemaker implantation (OR 0.23 [95% CI: 0.1, 0.53], P < 0.001). Discharge to home had a significantly higher odd ratio for sLOS (OR 8.67 [95% CI: 3.59, 23.11], P < 0.001). Conclusion In appropriately selected patients, sLOS following minimalist TAVR approach in an experienced and high volume center is feasible and safe. Implementing such a strategy may reduce medical costs with the potential clinical benefit of early re‐habilitation for the elderly TAVR population.