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

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. SOD in highly selected TAVR patients can facilitate the provision of essential cardiovascular care white 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 transfemorat 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 post-discharge. This strategy may have a potential rote in highly selected patients even when the COVID-19 pandemic abates. (C) 2022 by the American College of Cardiology Foundation.

Automated summary

Same-day discharge (SDD) after transcatheter aortic valve replacement (TAVR) is safe and feasible in selected patients at low risk for adverse clinical events post-discharge. This strategy provides essential cardiovascular care while managing competing COVID-19 resource demands.