Early discharge after transfemoral transcatheter aortic valve implantation
Early discharge after transfemoral transcatheter aortic valve implantation
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DOI：
10.1136/heartjnl-2014-307351
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发表时间：
2015-09-01
期刊：
影响因子：
5.7
通讯作者：
Tamburino, Corrado
中科院分区：
文献类型：
--
作者：
Barbanti, Marco;Capranzano, Piera;Tamburino, Corrado
背景本研究的目的是评估早期出院的可行性和安全性经股动脉经导管主动脉瓣植入术（TAVI）后（72小时内），并确定基线特征和/或围手术期变量，这可能会影响TAVI后的住院时间（LoS）。方法和结果患者在TAVI后72小时内出院（提前出院组）与连续3天后出院的患者（延迟出院组）进行比较。创建了比例为2：1的倾向匹配患者队列，以更好地控制混杂偏倚。在465例患者中，107例（23.0%）在术后3天内出院。对不匹配患者的多变量回归分析表明，基线纽约心脏病协会（NYHA）IV级（OR：0.22，95% CI 0.05 - 0.96; p= 0.045）和任何出血（OR：0.31，95% CI 0.74 - 0.92; p= 0.031）与TAVI后提前出院相关的可能性较小。相反，手术年份（OR：1.66，95% CI 1.25 - 2.20; p< 0.001）和TAVI前存在永久性起搏器（PPM）（OR：2.80，95% CI 1.36 - 5.75; p= 0.005）与提前出院的概率较高相关。在匹配的人群中，早期出院组的患者报告院内出血发生率较低（7.9% vs 19.4%，p= 0.014），严重血管并发症（2.3% vs 9.1%，p= 0.038）和PPM植入（7.9% vs18.5%，p= 0.021），而出院后30天时，两组在死亡方面无显著差异（2.2% vs 1.7%，p= 0.540），出血（0.0% vs 1.1%，p= 0.444），PPM植入（1.1% vs 0.0%，p= 0.333）和再次住院（1.1%对1.1%，p= 1.000）。（72小时内）经股动脉TAVI可行，似乎不会危及手术的早期安全性，当在通过临床判断选择的患者子集中进行时。血流动力学代偿不稳定的TAVI患者和术后出血的患者证明不适合这种方法，而TAVI后管理经验的增加与LoS的减少相关。
Background The aim of this study was to assess the feasibility and the safety of early discharge (within 72 h) after transfemoral transcatheter aortic valve implantation (TAVI) and to identify baseline features and/or peri-procedural variables, which may affect post-TAVI length-of-stay (LoS) duration.Methods and results Patients discharged within 72 h of TAVI (early discharge group) were compared with consecutive patients discharged after 3 days (late discharge group). Propensity-matched cohorts of patients with a 2: 1 ratio were created to better control confounding bias. Among 465 patients, 107 (23.0%) were discharged within 3 days of the procedure. Multivariable regression analysis of unmatched patients demonstrated that baseline New York Heart Association (NYHA) class IV (OR: 0.22, 95% CI 0.05 to 0.96; p= 0.045) and any bleeding (OR: 0.31, 95% CI 0.74 to 0.92; p= 0.031) were less likely to be associated with early discharge after TAVI. Conversely, the year of procedure (OR: 1.66, 95% CI 1.25 to 2.20; p< 0.001) and the presence of a permanent pacemaker (PPM) before TAVI (OR: 2.80, 95% CI 1.36 to 5.75; p= 0.005) were associated with a higher probability of early discharge. In matched populations, patients in the early discharge group reported lower incidence of in-hospital bleeding (7.9% vs 19.4%, p= 0.014), major vascular complications (2.3% vs 9.1%, p= 0.038) and PPM implantation (7.9% vs18.5%, p= 0.021), whereas after discharge, at 30-day, no significant differences were reported between groups in terms of death (2.2% vs 1.7%, p= 0.540), bleeding (0.0% vs 1.1%, p= 0.444), PPM implantation (1.1% vs 0.0%, p= 0.333) and rehospitalisation (1.1% vs 1.1%, p= 1.000).Conclusions Early discharge (within 72 h) after transfemoral TAVI is feasible and does not seem to jeopardise the early safety of the procedure, when performed in a subset of patients selected by clinical judgement. Patients undergoing TAVI in unstable haemodynamic compensation and patients experiencing bleeding after the procedure demonstrated to be poorly suitable to this approach, whereas increasing experience in post-TAVI management was associated with a reduction of LoS.