학술논문
Prespecified Risk Criteria Facilitate Adequate Discharge and Long-Term Outcomes After Transfemoral Transcatheter Aortic Valve Implantation.
Document Type
Academic Journal
Author
Spence MS; Cardiology Department Royal Victoria Hospital Belfast United Kingdom.; Baan J; Department of Cardiology Amsterdam UMCUniversity of Amsterdam The Netherlands.; Iacovelli F; Cardiology Department Department of Advanced Biomedical Sciences University of Naples Italy.; Cardiac Surgery Department Clinica San Gaudenzio Novara Italy.; Martinelli GL; Cardiology Department 'Montevergine' Clinic Mercogliano Italy.; Muir DF; Cardiothoracic Division The James Cook University Hospital Middlesbrough United Kingdom.; Saia F; Cardiovascular and Thoracic Department S. Orsola-Malpighi University Hospital Bologna Italy.; Bortone AS; Cardiology Department University of Bari 'Aldo Moro' Bari Italy.; Densem CG; Cardiology Department Papworth Hospital Cambridge United Kingdom.; Owens CG; Cardiology Department Royal Victoria Hospital Belfast United Kingdom.; van der Kley F; Cardiology Department Leiden University Medical Center Leiden The Netherlands.; Vis M; Department of Cardiology Amsterdam UMCUniversity of Amsterdam The Netherlands.; van Mourik MS; Department of Cardiology Amsterdam UMCUniversity of Amsterdam The Netherlands.; Costa G; Catania Division of Cardiology Policlinico-Vittorio Emanuele HospitalUniversity of Catania Italy.; Sykorova L; Edwards-Lifesciences Prague Czech Republic.; Lüske CM; Institute for Pharmacology and Preventive Medicine Cloppenburg Germany.; Deutsch C; Institute for Pharmacology and Preventive Medicine Cloppenburg Germany.; Kurucova J; Edwards-Lifesciences Prague Czech Republic.; Thoenes M; Edwards-Lifesciences Nyon Switzerland.; Bramlage P; Institute for Pharmacology and Preventive Medicine Cloppenburg Germany.; Tamburino C; Catania Division of Cardiology Policlinico-Vittorio Emanuele HospitalUniversity of Catania Italy.; Barbanti M; Catania Division of Cardiology Policlinico-Vittorio Emanuele HospitalUniversity of Catania Italy.
Source
Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE
Subject
Language
English
Abstract
Background Despite the availability of guidelines for the performance of transcatheter aortic valve implantation (TAVI), current treatment pathways vary between countries and institutions, which impact on the mean duration of postprocedure hospitalization. Methods and Results This was a prospective, multicenter registry of 502 patients to validate the appropriateness of discharge timing after transfemoral TAVI, using prespecified risk criteria from FAST-TAVI (Feasibility and Safety of Early Discharge After Transfemoral [TF] Transcatheter Aortic Valve Implantation), based on hospital events within 1-year after discharge. The end point-a composite of all-cause mortality, vascular access-related complications, permanent pacemaker implantation, stroke, cardiac rehospitalization, kidney failure, and major bleeding-was reached in 27.0% of patients (95% CI, 23.3-31.2) within 1 year after intervention; 7.5% (95% CI, 5.5-10.2) had in-hospital complications before discharge and 19.6% (95% CI, 16.3-23.4) within 1 year after discharge. Overall mortality within 1 year after discharge was 7.3% and rates of cardiac rehospitalization 13.5%, permanent pacemaker implantation 4.2%, any stroke 1.8%, vascular-access-related complications 0.7%, life-threatening bleeding 0.7%, and kidney failure 0.4%. Composite events within 1 year after discharge were observed in 18.8% and 24.3% of patients with low risk of complications/early (≤3 days) discharge and high risk and discharged late (>3 days) (concordant discharge), respectively. Event rate in patients with discordant discharge was 14.3% with low risk but discharged late and increased to 50.0% in patients with high risk but discharged in ≤3 days. Conclusions The FAST-TAVI risk assessment provides a tool for appropriate, risk-based discharge that was validated with the 1-year event rate after transfemoral TAVI. Registration URL: https://www.ClinicalTrials.gov; Unique identifier: NCT02404467.