Same-Day Discharge Post-Transcatheter Aortic Valve Replacement During the COVID-19 Pandemic The Multicenter PROTECT TAVR Study

• Type of Material: Article
• Authors: Madeleine Barker, University of British Columbia; Janarthanan Sathananthan, University of British Columbia; Emily Perdoncin, Emory University; Chandan Devireddy, Emory University; Patricia Keegan, Emory University; Kendra Grubb, Emory University; Andrei M. Pop, AMITA Alexian Brothers Medical Center; Jeremiah P. Depta, Rochester Regional Health; Devsih Rai, Rochester General Hospital; Farhad Abtahian, Rochester Regional Health
• Language: English
• Date: 2022-03-28
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Final Published Version
• Copyright Statement: © 2022 by the American College of Cardiology Foundation. Published by Elsevier.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jcin.2021.12.046
• Title of Journal or Parent Work: JACC-CARDIOVASCULAR INTERVENTIONS
• Volume: 15
• Issue: 6
• Start Page: 590
• End Page: 598
• Grant/Funding Information: Dr Sathananthan is a consultant to Edwards Lifesciences and Medtronic; and has received speaker fees from Edwards Lifesciences and NVT. Dr Devireddy has received consulting fees from Edwards Lifesciences, Medtronic, ReCor Medical, and Shockwave Medical. Ms Keegan is a consultant for Edwards Lifesciences, Medtronic, and Abbott Vascular. Dr Grubb is a speaker, proctor, and principal investigator for Edwards Lifesciences and Medtronic; and receives grants and educational funding to her employer from Edwards Lifesciences and Medtronic. Dr Spence has received consulting fees and/or institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Muir is a proctor for Edwards Lifesciences and Abbott Vascular; and has received departmental grants from Edwards Lifesciences and Abbott Vascular. Dr Russo is a speaker, proctor, and principal investigator for Edwards Lifesciences; and receives research funding to his employer from Edwards Lifesciences. Dr Pineda-Salazar receives research funding to her employer from Edwards Lifesciences. Ms Smith has received research funding to her employer from Edwards Lifesciences. Dr Dahle is a speaker, proctor, and principal investigator for Edwards Lifesciences and Medtronic. Dr Meier is supported by the Swiss National Science Foundation (grant P2LAP3_199561). Dr Akodad has received research funding from Medtronic, Biotronik, and Fédération Française de Cardiologie. Dr Nestelberger has received research support from the Swiss National Science Foundation (P400PM_191037/1), the Swiss Heart Foundation (FF20079), the Prof Dr Max Cloëtta Foundation, Margarete und Walter Lichtenstein-Stiftung (3MS1038), the University of Basel, and the University Hospital Basel; and has received speaker honoraria and consulting honoraria from Siemens, Beckman Coulter, Bayer, Ortho Clinical Diagnostics, and Orion. Dr Lauck is a consultant to Edwards Lifesciences. Dr Webb is a consultant to and receives unrestricted grant support from Medtronic, Edwards Lifesciences, and Abbott Vascular. Dr Wood has received consulting fees and/or institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
• Keywords: sameday discharge; NEXT-DAY DISCHARGE; COVID-19 pandemic; Cardiovascular System & Cardiology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Science & Technology; MANAGEMENT; transcatheter aortic valve replacement
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management

Abstract

Objectives: The aim of this study was to determine the safety and efficacy of same-day discharge (SDD) after transcatheter aortic valve replacement (TAVR) during the COVID-19 pandemic. Background: The COVID-19 pandemic has placed significant stress on health care systems worldwide. SDD in highly selected TAVR patients can facilitate the provision of essential cardiovascular care while managing competing COVID-19 resource demands. Methods: Patient selection for SDD was at the discretion of the local multidisciplinary heart team, across 7 international sites. The primary outcome was a composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new permanent pacemaker (PPM) implantation. Results: From March 2020 to August 2021, 124 of 2,100 patients who underwent elective transfemoral TAVR were selected for SDD. The average age was 78.9 ± 7.8 years, the median Society of Thoracic Surgeons score was 2.4 (IQR: 1.4-4.2), and 32.3% (n = 40) had preexisting PPMs. There were no major vascular complications, strokes, or deaths during the index admission. One patient (0.8%) required PPM implantation for complete heart block and was discharged the same day. No patient required a PPM between discharge home and 30-day follow-up. The composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new PPM at 30 days occurred in 5.7% patients (n = 6 of 106). Conclusions: SDD post-TAVR is safe and feasible in selected patients at low risk for adverse clinical events postdischarge. This strategy may have a potential role in highly selected patients even when the COVID-19 pandemic abates.