Safety and clínical outcomes of a lean, minimalist tavr pathway in a tertiary, public hospital in Brazil

ABSTRACT

INTRODUCTION: A lean, minimalist transcatheter aortic valve replacement (LmTAVR) pathway is broadly defined by the simplification of technical aspects of the procedure (local anesthesia, percutaneous access, transthoracic echo, etc.), combined with systematic care, comprehensive and multidisciplinary approach to optimize clinical outcomes and promote faster recovery of patients (pts), and is associated with reduced length of stay and hospital costs. Its implementation in the Brazilian Unified National Health System (SUS) is still limited, and requires the development and validation of specific protocols. OBJECTIVE: To describe the initial clinical outcomes, in- -hospital length of stay and rehospitalization rate at 30 days after the implementation of an institutional protocol for LmTAVI in a tertiary hospital of the SUS. METHODS: Observational and prospective study, with consecutive pts who underwent TAVR from Sep/20 to Jan/22. Exclusion criteria for LmTAVI were non-elective pts, left ventricular ejection fraction < 30%, non-femoral access, stage V kidney disease, dialysis, dyscrasias or thrombocytopenia, or pts scheduled for another combined procedure at admission. RESULTS: Of the 67 pts who underwent TAVI procedure in the period, 17 (25%) had exclusion criteria for LmTAVI. Regarding pts included in the minimalist approach (n=50), mean age was 79.2 ±4.8 years, mean STS 2.6 ±1.5% and 20 (40%) were women. One patient required permanent pacemaker implantation after LmTAVI; cardiovascular mortality at 30 days was 2%. Of the pts undergoing LmTAVI, 64% were discharged the next day after the procedure, and 86% were discharged within 48h. The 30-day cardiovascular readmission rate was 4%, due to stroke (n=1) and heart failure (n=1). CONCLUSION: In this initial experience, the development and implementation of a systematized and optimized protocol for patient care undergoing LmTAVI in a tertiary hospital of public health system in Brazil was feasible and safe. Majority of pts were discharged within 48h, with a low rate of rehospitalizations.