Postinterventional surveillance at a dedicated valve unit is safe and reduces intensive care utilization after TAVR.

IF 3.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Research in Cardiology Pub Date : 2025-06-02 DOI:10.1007/s00392-025-02676-7

B Gonska, M Krohn-Grimberghe, H Kirindi, T Stephan, J Mörike, C Buck, W Rottbauer, D Buckert

{"title":"Postinterventional surveillance at a dedicated valve unit is safe and reduces intensive care utilization after TAVR.","authors":"B Gonska, M Krohn-Grimberghe, H Kirindi, T Stephan, J Mörike, C Buck, W Rottbauer, D Buckert","doi":"10.1007/s00392-025-02676-7","DOIUrl":null,"url":null,"abstract":"Background: The postprocedural care pathway after transcatheter aortic valve replacement (TAVR) mostly includes monitoring patients for 24-48 h at an intensive care unit (ICU) or intermediate care unit (routine intensive care monitoring = ICM). To reduce the need for postprocedural intensive care surveillance, our center established a dedicated monitoring unit (valve unit = VU) for pre- and postprocedural care of TAVR patients.Methods: The aim of this prospective case-control study was to evaluate outcomes of patients directly before and after the introduction of the VU. Starting in April 2020 TAVR patients were directly transferred to a VU after the procedure with 24-h telemetric electrocardiogram (ECG) and non-invasive blood pressure monitoring, which was spatially integrated into a general cardiology ward. Patients with hemodynamic or respiratory instability, stroke, delirium, and severe bleeding complications were still directly transferred to the ICU.Results: 796 consecutive patients treated with TAVR at our center were included. 592 patients had been treated during ICM and 204 after the establishment of the VU. The overall rate of events was similar before and after the implementation of the valve unit. 182 of 592 ICM patients developed study-specific endpoints (30.7%) compared to 60 of 204 VU patients (29.4%) (P value for difference: 0.87). VU patients showed a trend towards a lower rate of delirium (ICM 3.5% vs VU 1%, p-value 0.06).Conclusion: Introduction of a VU for patient monitoring after TAVR with prespecified criteria for postinterventional ICU surveillance reduced the percentage of postinterventional ICU admissions by 73% without increasing the overall rate of adverse events.","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Research in Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00392-025-02676-7","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The postprocedural care pathway after transcatheter aortic valve replacement (TAVR) mostly includes monitoring patients for 24-48 h at an intensive care unit (ICU) or intermediate care unit (routine intensive care monitoring = ICM). To reduce the need for postprocedural intensive care surveillance, our center established a dedicated monitoring unit (valve unit = VU) for pre- and postprocedural care of TAVR patients.

Methods: The aim of this prospective case-control study was to evaluate outcomes of patients directly before and after the introduction of the VU. Starting in April 2020 TAVR patients were directly transferred to a VU after the procedure with 24-h telemetric electrocardiogram (ECG) and non-invasive blood pressure monitoring, which was spatially integrated into a general cardiology ward. Patients with hemodynamic or respiratory instability, stroke, delirium, and severe bleeding complications were still directly transferred to the ICU.

Results: 796 consecutive patients treated with TAVR at our center were included. 592 patients had been treated during ICM and 204 after the establishment of the VU. The overall rate of events was similar before and after the implementation of the valve unit. 182 of 592 ICM patients developed study-specific endpoints (30.7%) compared to 60 of 204 VU patients (29.4%) (P value for difference: 0.87). VU patients showed a trend towards a lower rate of delirium (ICM 3.5% vs VU 1%, p-value 0.06).

Conclusion: Introduction of a VU for patient monitoring after TAVR with prespecified criteria for postinterventional ICU surveillance reduced the percentage of postinterventional ICU admissions by 73% without increasing the overall rate of adverse events.

查看原文本刊更多论文

在专门的瓣膜单元进行介入后监测是安全的，可以减少TAVR后重症监护的使用。

背景：经导管主动脉瓣置换术（TAVR）后的术后护理途径主要包括在重症监护病房（ICU）或中间监护病房（常规重症监护监护= ICM）监测患者24-48小时。为了减少术后重症监护监护的需要，我中心建立了专门的监测单元（瓣膜单元= VU），对TAVR患者进行术前和术后监护。方法：本前瞻性病例对照研究的目的是评估患者在引入VU之前和之后的预后。从2020年4月开始，TAVR患者在接受24小时遥测心电图（ECG）和无创血压监测后，直接转移到VU，并在空间上整合到普通心脏病病房。有血流动力学或呼吸不稳定、脑卒中、谵妄和严重出血并发症的患者仍直接转入ICU。结果：本中心连续796例患者接受TAVR治疗。ICM期间治疗592例，VU建立后治疗204例。在实施阀门装置之前和之后，事件的总体发生率相似。592例ICM患者中有182例（30.7%）达到了研究特异性终点，而204例VU患者中有60例（29.4%）（P值差异为0.87）。VU患者谵妄发生率较低（ICM 3.5% vs VU 1%， p值0.06）。结论：采用预先设定的标准进行介入后ICU监测的TAVR患者VU的引入，在不增加总体不良事件发生率的情况下，将介入后ICU入院率降低了73%。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Research in Cardiology 医学-心血管系统

CiteScore

11.40

自引率

4.00%

发文量

140

审稿时长

4-8 weeks

期刊介绍： Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery. As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.