Same Day Discharge during the COVID-19 Pandemic in Highly Selected Transcatheter Aortic Valve Replacement Patients.

ABSTRACT

Background: Transcatheter aortic valve replacement (TAVR) with a standardized clinical pathway allows most patients to achieve safe next-day discharge. This approach has been successfully implemented across global centers as part of the Benchmark Program. Considering restricted hospital resources resulting from the COVID-19 pandemic, a modified same day discharge (SDD) clinical pathway was implemented for selected TAVR patients at a single Benchmark site. Methods: All patients accepted for TAVR were assessed for the SDD clinical pathway. Eligibility criteria included adequate social support and accessibility to the TAVR program post-discharge. Patients with preexisting conduction disease were excluded. The clinical pathway comprised of mobilization, bloodwork and electrocardiogram 4 hours post-TAVR and discharge ≥8 hours following groin hemostasis. Results: From June to December 2020, 142 patients underwent TAVR at a single community Benchmark site. Of those, 29 highly selected patients were successfully discharged the same day using the SDD clinical pathway. There were no vascular access complications, permanent pacemaker (PPM) implantation, or mortality in the SDD group during index admission or at 30-day follow-up. When compared to a standard therapy group, there was no statistically significant difference in 30-day cardiovascular readmission. Conclusions: This study demonstrates the safety and feasibility of same day discharge post-TAVR in a highly selected cohort of patients, with no observable difference in safety outcomes when compared to patients who were discharged according to standard institutional practice.Abbreviations AS aortic stenosis; ACT Activated clotting time; AV atrioventricular; AVB atrioventricular block; BBB bundle branch block; CAIC Canadian Society for Cardiovascular Angiography; CCL cardiac catheterization laboratory; CT Computed topography; CV cardiovascular; IQR Interquartile Range; IVCD intraventricular conduction delay; LBBB left bundle branch block; LOS length of stay; NDD next day discharge; PPM permanent pacemaker; RBBB right bundle branch block; SCAI Society for Cardiovascular Angiography and Intervention; SD standard deviation; SDD same day discharge; ST standard therapy; STS PROM society of thoracic surgeons predicted risk of mortality; TAVR transcatheter aortic valve replacement; TF transfemoral; THV transcatheter heart valve; TTE transthoracic echocardiogram; VARC Valve Academic Research Consortium.