Severe Symptomatic Aortic Stenosis Clinical Trial
Official title:
Evaluation of Length of Stay and Predisposing Factors of Late Discharge After Transfemoral Transcatheter Aortic Valve Implantation Using the SAPIEN-3 Prosthesis: A French Multicenter Prospective Observational Trial
Transcatheter aortic valve implantation (TAVI) has been rapidly adopted worldwide since the
first-in-man TAVI performed in 2002. With increasing experience and improvements in valve
design, the "minimalist" approach to transfemoral TAVI (using local anesthesia and
fluoroscopic guidance) has become an attractive concept, and the technical feasibility of
this approach has been well documented.
While earlier data showed prolonged length of stay after TF-TAVI [10.5 ± 8.1 days in the
FRANCE 2 registry and 10.2 ± 11.1 days in the PARTNER Cohort A data, the UK TAVI registry
(reference) showed a decline in post-TAVI length of stay from 10 days to 8 days over the time
period of 2007 to 2012. More contemporary data from other centers has been published showing
that 23% of TF-TAVI patients were discharged within 3 days after TAVI. With an increasingly
minimalist approach to TF-TAVI, the duration of monitoring required post-procedure remains
indeterminate with a lack of formal consensus.
Early discharge (within 3 days of TAVI) is hypothesized to have multiple potential
advantages, including reduction in unnecessarily lengthy hospitalization of frail and elderly
patients in addition to cost-saving benefits. Rouen University Hospital has previously
published a retrospective study on the feasibility and safety of early discharge, in which
discharge within 72 hours of uncomplicated TF-TAVI was safe and attained in 36% of our
patients. Pre-existing pacemaker and the absence of acute kidney injury were independent
predictors of a successful early discharge. Moreover, in a prospective study, Rouen
University Hospital recently shown that early discharge afterelective TF-TAVI with
SAPIEN-XT/SAPIEN-3 prostheses was attainable in a large proportion of patients (59%) with no
evident compromise in safety. Factors associated with failure of early discharge were
postprocedural blood transfusion and permanent pacemaker implantation. But currently, there
are no guidelines for the length of stay after a TF-TAVI.
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