Next-day discharge after transcatheter aortic valve replacement in a Dutch hospital.

Abstract

Background: In recent years, hospital stays after transcatheter aortic valve replacement (TAVR) have shortened. Previous studies have shown that next-day discharge (NDD) is feasible without compromising patient safety, but data from the Dutch hospital setting are lacking. To assess the real-world effect of a NDD policy after TAVR.

Methods: A next-day discharge policy was introduced in 2022 at St. Antonius Hospital Nieuwegein, the Netherlands. We included elective TAVR patients between August 2022 and August 2024, excluding those with pre-existing hospitalisation, transapical access, or intraprocedural mortality.

Results: Among 460 patients (mean age 80.1 ± 6.2 years, 40.9% female, and a median Edmonton Frail score of 3.0 [1.0-4.0]), the majority underwent transfemoral TAVR (99.1%), under local anaesthesia (97.0%), using self-expanding valves (78.3%). Patients in the NDD group were more often male, less frail, and less likely to have right bundle branch block before TAVR compared to delayed discharge (DD) patients. NDD was feasible in 269 patients (58.5%) with a low number of post-discharge complications at 30 days: 1.9% permanent pacemaker implantation and 2.2% minor vascular complications. There were no cases of mortality, major vascular complications, or in-hospital stroke. Main reasons for DD were conduction disorders, access site complications, and stroke, which contributed to a higher incidence of complications in the DD group (18.3% permanent pacemaker implantation, p < 0.001, 3.1% stroke, p = 0.004, 1.6% major vascular complication, overall p-value 0.02).

Conclusion: After implementing an NDD policy, 58.5% of patients were eligible for NDD after TAVR with a very low post-discharge complication rate.