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Predictors and Safety of Next-Day Discharge in Unselected Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation.

AIMS
To evaluate predictors and safety of next-day discharge (NDD) after transfemoral transcatheter aortic valve implantation (TF-TAVI) in unselected patients receiving either balloon- or self-expanding devices.


METHODS AND RESULTS
From June 2007 to August 2018, 1,232 consecutive patients undergoing TF-TAVI were discharged alive from our Institution. They had a mean age of 80.9±5.4 years and an intermediate estimated surgical mortality risk, and received either balloon-(26.1%) or self-expanding prostheses (73.9%). We compared patients discharged within 24 hours from the procedure (n=160,13.0%) with those discharged later, and accounted for confounding variables through a propensity matching adjustment. After adjustment, no differences in all-cause mortality (1.2% vs. 0.0%, for NDD and no-NDD matched groups respectively, p=0.16) and permanent pacemaker implantation (PPI) after TAVI (0.6% vs. 0.6%) were encountered at 30 days. At 1 year, no difference in composite endpoint of all-cause death and heart failure (HF) rehospitalization was encountered (KM estimates 91.9% vs. 90.6% for NDD and no-NDD matched groups respectively, p=0.69). After excluding patients with post-procedural major complications from the unmatched population, prior PPI (OR:2.06; 95% CI:1.21-3.51; p<0.01) and availability of pre-procedural computed tomography angiography (CTA) (OR:1.71; CI:1.15-2.54; p<0.01) were found to be predictors of NDD after TAVI.


CONCLUSIONS
NDD in unselected patients after TF-TAVI using either balloon- or self-expanding devices demonstrated to be a safe strategy up to 1 year in absence of procedural complications. Patients with prior PPI and undergoing pre-procedural CTA had a higher chance of NDD.