Archives of cardiovascular diseases · 2026
Feasibility and safety of "fast-track" protocol after TAVI.
СтатьяНазвание и аннотация: Перевод в очереди
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Rahmani Sami, Polo Julien, Boyer Jeremy, Roussel Thomas, Morera Pierre, Jaussaud Nicolas, Porto Alizée, Collart Frédéric, Deharo Pierre, Cuisset Thomas
Аннотация
BACKGROUND: Transcatheter aortic valve implantation is the standard treatment for symptomatic severe aortic stenosis. Advances in technology and minimally invasive techniques have made early discharge following transcatheter aortic valve implantation a feasible and safe option, optimizing hospital resource utilization without compromising care quality.
AIM: To evaluate the feasibility and safety of early discharge ("fast-track") following transcatheter aortic valve implantation in a single high-volume centre.
METHODS: This single-centre retrospective study included consecutive patients undergoing transcatheter aortic valve implantation (TAVI) for symptomatic severe aortic stenosis between April 2022 and December 2023. Patients were stratified into FT- (ineligible), FT+/+ (next day discharge achieved), and FT+/- (early discharge failed) groups. The primary endpoint was a 3-month composite safety outcome.
RESULTS: Between April 2022 and December 2023, 506 patients aged>18 years with severe symptomatic aortic stenosis underwent transcatheter aortic valve implantation at the University Hospital of Marseille Timone; of these, 479 patients were included in the analysis. Overall, 80.8% (n=409; 95% confidence interval 77.2-84.0%) of the total patient population were eligible for fast track (FT+). The primary reason for ineligibility (FT-) was the presence of complete right bundle branch block (49.6%, n=54; 95% confidence interval 40.1-59.2%). Among FT+ patients, 69.9% (n=286; 95% confidence interval 65.3-74.1%) were discharged the next day (FT+/+); the early discharge strategy failed in 30.1% (n=123) (FT+/-). Prolonged rhythm monitoring as a result of acquired conduction disorders delayed discharge in 55.9% (n=76; 95% confidence interval 47.0-64.3%) of FT+/- cases. High-grade conduction disorders necessitated a mean wait of 4.1 days for pacemaker implantation. At 3-month follow-up, cardiovascular events occurred in 4.4% (n=12/275) of FT+/+ patients, 6.9% (n=8/116) of FT+/- patients and 11.4% (n=10/88) of FT- patients (P=0.06).
CONCLUSIONS: Next-day discharge after transcatheter aortic valve implantation was feasible and safe for 69.9% of eligible patients (representing 56.5% of the overall cohort). Eligibility for the fast track protocol was achieved in 80.8% of patients. Conduction disturbances and vascular complications remain key obstacles leading to prolonged hospital stays and requiring optimization.
AIM: To evaluate the feasibility and safety of early discharge ("fast-track") following transcatheter aortic valve implantation in a single high-volume centre.
METHODS: This single-centre retrospective study included consecutive patients undergoing transcatheter aortic valve implantation (TAVI) for symptomatic severe aortic stenosis between April 2022 and December 2023. Patients were stratified into FT- (ineligible), FT+/+ (next day discharge achieved), and FT+/- (early discharge failed) groups. The primary endpoint was a 3-month composite safety outcome.
RESULTS: Between April 2022 and December 2023, 506 patients aged>18 years with severe symptomatic aortic stenosis underwent transcatheter aortic valve implantation at the University Hospital of Marseille Timone; of these, 479 patients were included in the analysis. Overall, 80.8% (n=409; 95% confidence interval 77.2-84.0%) of the total patient population were eligible for fast track (FT+). The primary reason for ineligibility (FT-) was the presence of complete right bundle branch block (49.6%, n=54; 95% confidence interval 40.1-59.2%). Among FT+ patients, 69.9% (n=286; 95% confidence interval 65.3-74.1%) were discharged the next day (FT+/+); the early discharge strategy failed in 30.1% (n=123) (FT+/-). Prolonged rhythm monitoring as a result of acquired conduction disorders delayed discharge in 55.9% (n=76; 95% confidence interval 47.0-64.3%) of FT+/- cases. High-grade conduction disorders necessitated a mean wait of 4.1 days for pacemaker implantation. At 3-month follow-up, cardiovascular events occurred in 4.4% (n=12/275) of FT+/+ patients, 6.9% (n=8/116) of FT+/- patients and 11.4% (n=10/88) of FT- patients (P=0.06).
CONCLUSIONS: Next-day discharge after transcatheter aortic valve implantation was feasible and safe for 69.9% of eligible patients (representing 56.5% of the overall cohort). Eligibility for the fast track protocol was achieved in 80.8% of patients. Conduction disturbances and vascular complications remain key obstacles leading to prolonged hospital stays and requiring optimization.