The Canadian journal of cardiology · 2025
The Safety and Feasibility of Same-Day Discharge for Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Litkouhi Princess Neila, Rao Karan, Baer Alexandra, Hansen Peter S, Bhindi Ravinay
Аннотация
BACKGROUND: Next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR) has been shown to be safe in appropriately selected patients and has been implemented into clinical practice. As the demand for TAVR grows, improving its accessibility is crucial. Several studies have trialled same-day discharge (SDD) after TAVR, but a review has not been performed.
METHODS: Five databases were searched. Baseline demographics, study characteristics and the assessment criteria used to determine eligibility for SDD were extracted and compared. Proportional meta-analysis was used to compare post-TAVI outcomes between SDD and NDD patients.
RESULTS: Six studies were included from 1734 screened articles. Of 3519 patients, 318 (9.0%) underwent SDD (mean age 78.2 ± 8.7 years, 59.3% male). Balloon-expandable valves were used in 91.6% of cases, and self-expanding valves in the remaining 8.4%. Patients that underwent SDD experienced lower rates of mortality (OR 0.104, 95% CI 0.015-0.998), all-cause readmission (OR 0.194, 95% CI 0.052-0.717), cardiovascular readmissions (OR 0.155, 95% CI 0.026-0.971), and new pacemaker requirement (OR 0.167, 95% CI 0.028-0.995) at 30 days after TAVR compared with patients that underwent NDD. There was no difference in rates of stroke (OR 0.407, 95% CI 0.015-16.694) or major vascular complications (0.0% vs 0.0%).
CONCLUSIONS: Current evidence supports the safety and feasibility of SDD after elective transfemoral TAVR in appropriately selected patients. Heterogeneity between eligibility criteria used to select patients for SDD, especially related to conduction disease, poses a barrier to implementation. Further research on self-expanding valves is needed.
METHODS: Five databases were searched. Baseline demographics, study characteristics and the assessment criteria used to determine eligibility for SDD were extracted and compared. Proportional meta-analysis was used to compare post-TAVI outcomes between SDD and NDD patients.
RESULTS: Six studies were included from 1734 screened articles. Of 3519 patients, 318 (9.0%) underwent SDD (mean age 78.2 ± 8.7 years, 59.3% male). Balloon-expandable valves were used in 91.6% of cases, and self-expanding valves in the remaining 8.4%. Patients that underwent SDD experienced lower rates of mortality (OR 0.104, 95% CI 0.015-0.998), all-cause readmission (OR 0.194, 95% CI 0.052-0.717), cardiovascular readmissions (OR 0.155, 95% CI 0.026-0.971), and new pacemaker requirement (OR 0.167, 95% CI 0.028-0.995) at 30 days after TAVR compared with patients that underwent NDD. There was no difference in rates of stroke (OR 0.407, 95% CI 0.015-16.694) or major vascular complications (0.0% vs 0.0%).
CONCLUSIONS: Current evidence supports the safety and feasibility of SDD after elective transfemoral TAVR in appropriately selected patients. Heterogeneity between eligibility criteria used to select patients for SDD, especially related to conduction disease, poses a barrier to implementation. Further research on self-expanding valves is needed.