Background

Complications decrease after transfemoral transcatheter aortic valve implantation (TAVI), and early discharge is feasible and safe in selected populations.

Aims

To evaluate length of stay (LOS) and reasons for prolonged hospitalisation after transfemoral TAVI in unselected patients.

Methods

Patients with severe aortic stenosis, who had transfemoral TAVI with the SAPIEN 3 prosthesis using exclusively local anaesthesia, were prospectively and consecutively included at five French high-volume centres. LOS was calculated from TAVI procedure to discharge. Reasons for prolonged hospitalisation (i.e. > 3 days) were evaluated.

Results

Between 2017 and 2018, 293 patients were included, with a mean age of 82.4 ± 6.5 years and a mean logistic EuroSCORE of 13.7 ± 9.0%. The in-hospital mortality rate was 1.4%. The median LOS was 5 (3–7) days, and varied considerably between centres (from 2 to 7 days). Sixty-four (21.8%) patients were discharged within 3 days after transfemoral TAVI. Reported reasons for prolonged hospitalisation were complications in 62.2%, loss of autonomy in 3.1%, discharge refusal in 2.2% and logistical reasons in 0.9%. In 31.6% of cases, the investigators reported no apparent reasons.

Conclusions

The results of our study suggest that LOS after transfemoral TAVI, using the SAPIEN 3 prosthesis and a minimalist approach, varies considerably between centres. In almost a third of cases, hospitalisation was prolonged without any apparent reason. Efforts should be made to educate centres to reduce LOS.

中文翻译：

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SAPIEN 3假体经股动脉导管主动脉瓣植入术后的住院时间评估：一项法国多中心前瞻性观察性试验。

背景

经股动脉导管主动脉瓣植入术（TAVI）后并发症减少，在某些人群中尽早出院是可行且安全的。

目的

评估未选择患者经股骨TAVI后的住院时间（LOS）和长期住院的原因。

方法

在五个法国大容量医疗中心中，前瞻性地连续纳入了严重的主动脉瓣狭窄患者，这些患者仅使用局部麻醉进行了SAPIEN 3假体的股动脉TAVI治疗。从TAVI程序到出院计算LOS。评估了延长住院时间（> 3天）的原因。

结果

在2017年至2018年之间，共纳入293位患者，平均年龄为82.4±6.5岁，逻辑逻辑EuroSCORE为13.7±9.0％。住院死亡率为1.4％。中位LOS为5（3-7）天，中心之间差异很大（从2天到7天）。经股动脉TAVI后3天内出院的患者为64名（21.8％）。据报道，住院时间延长的原因包括并发症（62.2％），丧失自主能力（3.1％），拒绝出院（2.2％）和后勤原因（0.9％）。在31.6％的案件中，调查人员报告没有明显的原因。

结论

我们的研究结果表明，使用SAPIEN 3假体和极简方法，经股骨TAVI后的LOS在各中心之间差异很大。在几乎三分之一的病例中，住院时间延长没有任何明显的原因。应努力教育中心以减少服务水平。