Same-Day Discharge After Transcatheter Aortic Valve Replacement (TAVR)

Note: This article is reprinted from Cardiac Care: An Update for Physicians from the Heart, Vascular and Thoracic Institute (Spring 2024)

Transcatheter aortic valve replacement (TAVR), a minimally invasive procedure for severe aortic stenosis, has traditionally involved a hospital stay for post-procedural monitoring. However, advances in technique have enabled a paradigm shift towards same-day discharge, offering an opportunity for patients to enjoy an expedited recovery in the familiar comforts of home.

Cleveland Clinic in Florida is committed to innovation in cardiac care including embracing same-day discharge protocols for eligible TAVR patients, which offers several notable benefits to both patients

and healthcare systems. Patients experience reduced exposure to hospital-acquired infections and enjoy a faster return to their routine activities. This approach also optimizes hospital resources, allowing for efficient utilization of beds and a smoother patient flow within the healthcare system.

Procedural factors determine eligibility

The feasibility of same-day discharge relies mostly on procedural factors, as neither patient age nor the Society of Thoracic Surgeons (STS) risk score are predictors of readmission. Results of the multicenter PROTECT TAVR study in 2022 showed a 2.8% rate of 30-day cardiovascular readmission among 124 patients selected for same-day discharge after TAVR. The mean age of the patients was 78 years and median STS score was 2.4%.

Procedural factors include a minimalist approach under moderate sedation, primary percutaneous femoral access, secondary transradial access, completion of a femoral angiogram to confirm hemostasis, and absence of complications.

Post-procedural care includes a 6-hour observation period with telemetry monitoring for delayed rhythm disturbances, hemodynamic stability, and comfortable ambulation. Patients with new (such as left bundle branch block) or pre-existing conduction deficits require longer observation. Transthoracic echocardiography is performed before discharge.

The results of an additional study confirmed that when the above-mentioned procedural factors and post-procedural care were in place, same-day discharge after TAVR was feasible without risk to patient safety post-discharge.

Our multidisciplinary team, comprising experienced interventional cardiologists, cardiac surgeons, anesthesiologists, and specialized nursing staff, meticulously evaluates each patient to ensure suitability for same-day discharge, considering additional factors such as social support and proximity to a medical center, should a problem arise. Patients discharged on the same day are provided a direct phone number for questions and are expected to return for a follow-up visit that includes electrocardiogram within 24 to 48 hours.

As part of our ongoing commitment to optimizing patient care, Cleveland Clinic in Florida remains dedicated to advancing patient management strategies. Our relentless pursuit of excellence, coupled with a patient-centric approach, continues to shape the future of cardiovascular care, allowing us to offer innovative solutions like same-day discharge after structural interventions to enhance patient outcomes and experiences.

Dr. Cohen is Director of Structural Heart Interventions at Cleveland Clinic Weston Hospital.