Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (May 2024)

Temporal Trends, Outcomes, and Predictors of Next‐Day Discharge and Readmission Following Uncomplicated Evolut Transcatheter Aortic Valve Replacement: A Propensity Score–Matched Analysis

  • Wayne B. Batchelor,
  • Carlos E. Sanchez,
  • Paul Sorajja,
  • James E. Harvey,
  • Benjamin Z. Galper,
  • Anapoorna Kini,
  • Patricia Keegan,
  • Kendra J. Grubb,
  • Ruth Eisenberg,
  • Toby Rogers

DOI
https://doi.org/10.1161/JAHA.123.033846
Journal volume & issue
Vol. 13, no. 9

Abstract

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Background Next‐day discharge (NDD) outcomes following uncomplicated self‐expanding transcatheter aortic valve replacement have not been studied. Here, we compare readmission rates and clinical outcomes in NDD versus non‐NDD transcatheter aortic valve replacement with Evolut. Methods and Results Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry patients (n=29 597) undergoing elective transcatheter aortic valve replacement with self‐expanding supra‐annular valves (Evolut R, PRO, and PRO+) from July 2019 to June 2021 were stratified by postprocedure length of stay: ≤1 day (NDD) versus >1 day (non‐NDD). Propensity score matching was used to compare risk adjusted 30‐day readmission rates and 1‐year outcomes in NDD versus non‐NDD, and multivariable regression to determine predictors of NDD and readmission. Between the first and last calendar quarter, the rate of NDD increased from 45.4% to 62.1% and median length of stay decreased from 2 days to 1. Propensity score matching produced relatively well‐matched NDD and non‐NDD cohorts (n=10 549 each). After matching, NDD was associated with lower 30‐day readmission rates (6.3% versus 8.4%; P<0.001) and 1‐year adverse outcomes (death, 7.0% versus 9.3%; life threatening/major bleeding, 1.6% versus 3.4%; new permanent pacemaker implantation/implantable cardioverter‐defibrillator, 3.6 versus 11.0%; [all P<0.001]). Predictors of NDD included non‐Hispanic ethnicity, preexisting permanent pacemaker implantation/implantable cardioverter‐defibrillator, and previous surgical aortic valve replacement. Conclusions Most patients undergoing uncomplicated self‐expanding Evolut transcatheter aortic valve replacement are discharged the next day. This study found that NDD can be predicted from baseline patient characteristics and was associated with favorable 30‐day and 1‐year outcomes, including low rates of permanent pacemaker implantation and readmission.

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