Abstract 13274: The Safety of Early Discharge After Tavi in Northern and Rural Ontario Canada

Abstract

Introduction: Early hospital (<48hrs) discharge following transcatheter aortic valve implantation (TAVI) is an increasingly adopted practice. However, the safety of such an approach among patients residing in rural areas in Northern Ontario, including remote and medically underserved areas is lacking. Methods: After adapting the Vancouver 3M clinical pathway, all patients who underwent TAVI in Sudbury, Ontario were included in the analysis. The primary endpoint was all-cause mortality within 30 days. Secondary endpoints included procedural complications, post-TAVI length of hospital stay (LOS) and 30-day re-hospitalizations. Results: 165 patients underwent TAVI after adapting the Vancouver 3M clinical pathway. Mean age was 81 years (SD ± 8). Median STS-mortality score was 2.5% (IQR, 1.9-3.5). There was one in-hospital death (0.6%) with no 30 day mortality observed beyond hospital discharge. 11 patients (6.7%) required rehospitalization within 30 days, 3 of them for cardiac complaints. More over, after adoption of the 3M clinical pathway, the need for procedural mechanical ventilation and surgical vascular cut-down declined from 100% and 97% at baseline, to 6% and 2% respectively. Similarly, after adapting the 3M clinical pathway, the number of patients receiving TAVI on a given procedural day increased from two to three patients. Median post TAVI-LOS declined from 5 days (2-6 days) to 1 day (1-3 days). Conclusions: By transitioning to a 3M approach, our study has shown that early discharge after TAVI in Northern Ontario at a single lower-volume TAVI centre is feasible and safe, with favorable outcomes and improved hospital LOS. Furthermore, resource utilization improved with fewer patients requiring mechanical ventilation and surgical cut-down, leading to a downstream increase in the number of patients receiving TAVI on a given procedural day. This experience can potentially improve TAVI equity for underserved and vulnerable populations, reduce TAVI wait times and bridge variations in TAVI funding.