Analysis of Length of Hospital Stay after Transfemoral Transcatheter Aortic Valve Implantation: Results from the FRANCE TAVI (FRench Transcatheter Aortic Valve Implantation) Registry
Eric Durand1, Guillaume Avinée1, Christophe Tron1, Martine Gilard2, Jean Philippe Verhoye3, René Koning4, Thierry Lefevre5, Eric Van Belle6, Pascal Leprince7, Bernard Iung8, Hervé Le Breton3, Helene Eltchaninoff1.
1CHU de Rouen, Rouen, France, 2CHU de Brest, Brest, France, 3CHU de Rennes, Rennes, France, 4Clinique Saint Hilaire, Rouen, France, 5Institut Hospitalier Jacques Cartier, Massy, France, 6CHU de Lille, Lille, France, 7Pitie Sapetriere Hospital, Paris, France, 8Bichat Hospital, Paris, France.
Objectives: Transcatheter aortic valve implantation (TAVI) is playing a growing role in the management of patients with symptomatic severe aortic stenosis. However, length of hospital stay (LOS) after transfemoral (TF) TAVI remains widely variable and there is no consensus on LOS after a TAVI. We aimed to evaluate LOS after TF TAVI and its variability among different French centers using data from the FRANCE TAVI registry. Methods: TAVI was performed in 12,804 patients between January 2013 and December 2015. LOS was evaluated in 5,857 (45.7%) patients treated via a TF approach and discharged directly at home.. The study population was divided into 2 groups based on tertile LOS values. Results: The median LOS in the overall studied population was 7 (5-9) days and was extremely variable among centers. Patients in the lowest tertile (LOS <6 days, n=2,233) constituted the “Early Discharge” group, and patients with a length of stay >6 days (n=3,624) constituted the “Late Discharge group”. Variables independently associated with late discharge were co-morbidities, complications occurring during or after TAVI (need for a new pacemaker, tamponade, stroke, vascular complications and acute kidney injury), the use of self-expandable valve and general anesthesia with a significant center effect. In contrast, history of previous pacemaker before TAVI was a protective factor. Finally, we did not observe any significant difference in the rate of 30-day death and re-admission in the early versus late discharge groups (3.3% vs. 3.5%, p = 0.66). Conclusions: LOS remains high after TF TAVI in France and extremely variable among centers. As expected, co-morbidities and complications were predictive factors of late discharge after TAVI. Furthermore, the results of our study suggest that the use of self-expandable prosthesis and general anesthesia also contribute to late discharge. Our results confirm that early discharge is safe.
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