Evaluation of length of stay after transfemoral transcatheter aortic valve implantation with SAPIEN 3 prosthesis: A French multicentre prospective observational trial.

Abstract

BACKGROUND:

Complications decrease after transfemoral transcatheter aortic valve implantation (TAVI), and early discharge is feasible and safe in selected populations.

AIMS:

To evaluate length of stay (LOS) and reasons for prolonged hospitalisation after transfemoral TAVI in unselected patients.

METHODS:

Patients with severe aortic stenosis, who had transfemoral TAVI with the SAPIEN 3 prosthesis using exclusively local anaesthesia, were prospectively and consecutively included at five French high-volume centres. LOS was calculated from TAVI procedure to discharge. Reasons for prolonged hospitalisation (i.e.>3 days) were evaluated.

RESULTS:

Between 2017 and 2018, 293 patients were included, with a mean age of 82.4±6.5 years and a mean logistic EuroSCORE of 13.7±9.0%. The in-hospital mortality rate was 1.4%. The median LOS was 5 (3-7) days, and varied considerably between centres (from 2 to 7 days). Sixty-four (21.8%) patients were discharged within 3 days after transfemoral TAVI. Reported reasons for prolonged hospitalisation were complications in 62.2%, loss of autonomy in 3.1%, discharge refusal in 2.2% and logistical reasons in 0.9%. In 31.6% of cases, the investigators reported no apparent reasons.

CONCLUSIONS:

The results of our study suggest that LOS after transfemoral TAVI, using the SAPIEN 3 prosthesis and a minimalist approach, varies considerably between centres. In almost a third of cases, hospitalisation was prolonged without any apparent reason. Efforts should be made to educate centres to reduce LOS.

• Authors: Eric Durand, Hervé Le Breton, Thierry Lefevre, Martine Gilard, Dominique Himbert, Marina Urena Alcazar, Nicolas Bettinger, Vincent Auffret, Romain Didier, Bernard Chevalier, Delphine M Béziau, Bernard Iung, Hélène Eltchaninoff
• Journal: Archives of cardiovascular diseases (Arch Cardiovasc Dis) 2020 Jun - Jul Vol. 113 Issue 6-7 Pg. 391-400 ISSN: 1875-2128 [Electronic] Netherlands
• PMID: 32418883 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2020 Elsevier Masson SAS. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aortic Valve (diagnostic imaging, physiopathology, surgery)
• Aortic Valve Stenosis (diagnostic imaging, mortality, physiopathology, surgery)
• Catheterization, Peripheral (adverse effects)
• Female
• Femoral Artery
• Hospital Mortality
• Humans
• Length of Stay
• Male
• Patient Discharge
• Prospective Studies
• Registries
• Risk Factors
• Severity of Illness Index
• Time Factors
• Transcatheter Aortic Valve Replacement (adverse effects, mortality)
• Treatment Outcome