Evaluation of Length of Stay After TF-TAVI
Evaluation of Length of Stay After TF-TAVI
Transcatheter aortic valve implantation (TAVI) has been rapidly adopted worldwide since the
 first-in-man TAVI performed in 2002. With increasing experience and improvements in valve
 design, the "minimalist" approach to transfemoral TAVI (using local anesthesia and
 fluoroscopic guidance) has become an attractive concept, and the technical feasibility of
 this approach has been well documented.

 While earlier data showed prolonged length of stay after TF-TAVI [10.5 ± 8.1 days in the
 FRANCE 2 registry and 10.2 ± 11.1 days in the PARTNER Cohort A data, the UK TAVI registry
 (reference) showed a decline in post-TAVI length of stay from 10 days to 8 days over the time
 period of 2007 to 2012. More contemporary data from other centers has been published showing
 that 23% of TF-TAVI patients were discharged within 3 days after TAVI. With an increasingly
 minimalist approach to TF-TAVI, the duration of monitoring required post-procedure remains
 indeterminate with a lack of formal consensus.

 Early discharge (within 3 days of TAVI) is hypothesized to have multiple potential
 advantages, including reduction in unnecessarily lengthy hospitalization of frail and elderly
 patients in addition to cost-saving benefits. Rouen University Hospital has previously
 published a retrospective study on the feasibility and safety of early discharge, in which
 discharge within 72 hours of uncomplicated TF-TAVI was safe and attained in 36% of our
 patients. Pre-existing pacemaker and the absence of acute kidney injury were independent
 predictors of a successful early discharge. Moreover, in a prospective study, Rouen
 University Hospital recently shown that early discharge afterelective TF-TAVI with
 SAPIEN-XT/SAPIEN-3 prostheses was attainable in a large proportion of patients (59%) with no
 evident compromise in safety. Factors associated with failure of early discharge were
 postprocedural blood transfusion and permanent pacemaker implantation. But currently, there
 are no guidelines for the length of stay after a TF-TAVI.
Inclusion Criteria:

 -  Stable patients with severe symptomatic aortic stenosis

 -  Patient undergoing planned TF-TAVI with the SAPIEN-3 prosthesis,

 -  TF-TAVI using a minimalist approach of local anesthesia and conscious sedation

 Exclusion Criteria:

 -  The use of other (than Edwards SAPIEN-3 or XT) transcatheter aortic valve devices.

 -  TF-TAVI requiring general anesthesia or surgical cut-down.

 -  TF-TAVI performed in unstable patients or on an urgent/emergent basis.

 -  Non-transfemoral routes of valve delivery (eg. transapical, transaortic, etc).

 -  Discharge back home impossible (including transfer in another hospital)

 -  Programmed transfer to another hospital