Implementing a fast-track TAVI pathway in times of COVID-19: necessity or opportunity?

Abstract

To the Editor, Despite the expansion of transcatheter aortic valve implantation (TAVI) to lower-risk patients, the length of stay after TAVI remains high for an average 8 days according to the Spanish TAVI registry.1 Recently published studies have demonstrated that early discharge following balloon-expandable transfemoral TAVI is feasible and safe.2,3 The unprecedented demand sustained by the healthcare services during the current COVID-19 pandemic has led to redirecting assets and restricting many cardiovascular procedures to protect the limited resources available like anesthesia support, ventilators, and critical care infrastructures. The present fast-track protocol was developed in response to the COVID-19 pandemic to assess the safety and feasibility of early discharge after minimalist TAVI with either balloon-expandable or self-expanding valves in our setting. Patients undergoing transfemoral TAVI were prospectively recruited. The inclusion criteria in the fast-track pathway were based on the 3M TAVI study: femoral access eligible for percutaneous closure, body mass index < 35, low-risk aortic annulus anatomy (coronary height > 10 mm, tricuspid valve, non-severe left ventricular outflow tract calcification), ejection fraction ≥ 30%, low anticipated risk of advanced conduction disturbances (PR interval < 240 ms, absence of right bundle branch block), familial support within the first 24-48 hours. All procedures were performed...