Integrate evaluation of clinical, electrocardiographic and procedural predictors for early discharge after transcatheter aortic valve implantation

SUMMARY Aims: TAVI is nowdays a worldwide accepted therapy for treating patients with severe aortic stenosis. The aim of the study is to identify clinical, electrocardiographic and procedural predictors of fast-track discharge in patients who underwent TAVI, simplifying the procedure and obtaining a shorter length of hospital stay (LoS). Methods: Patients treated with TAVI by transfemoral approach from November 2019 to December 2021 were categorized according to the LoS. “Fast-Track” (FT) population, with a post-procedural LoS less or equal to 3 days, was compared to the “Slow-Track” (ST) population with a post-procedural LoS greater than 3 days. Results: 318 patients were enrolled in the study. Although was observed a homogeneous distribution of the population and baseline characteristics were similar between the two groups, ST group showed a higher surgical risk (p<0.001) and a higher rate of new pace-maker implantation (p= 0.038). No difference was observed, between the ST and FT patients, concerning death and cardiovascular rehospitalization up to 30-days and one-year follow-up. In the univariate analysis, STS score ≥ 4% (OR: 2.22; p<0.001) and In-hospital new PM (OR: 2.75; p=0.033) were associated with higher likelihood of longer hospital stay after TAVI. In the multivariate analysis both of them (p=0.008 and p=0.033 respectively) were independently associated with a higher probability of ST. Conclusions: Patients undergoing TAVI who have a FT course can be safely discharged home, without compromising the safety and efficacy of the procedure, with no difference in primary and secondary clinical endpoints compared with the ST group. The STS score and in-hospital new PM implantation after TAVI turned out to be predictors of ST.