Analysis of disparities in length of hospital stay after transfemoral transcatheter aortic valve implantation: Results from the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) Registry

Abstract

Transcatheter aortic valve implantation (TAVI) is playing a growing role in the management of patients with symptomatic severe aortic stenosis. However, length of hospital stay (LOS) after transfemoral (TF) TAVI remains widely variable among centers. We aim to evaluate LOS after TF TAVI and its variability of LOS among French centers using data from the large national FRANCE TAVI registry. TAVI was performed in 12,804 patients in 48 French centers between January 2013 and December 2015 using TF approach in 87.2%. In-hospital mortality was 4.4%. Patients were discharged at home in 52.9%. LOS was evaluated in 5857 (45.7%) patients implanted via a TF approach and discharged at home. The median of LOS in the overall studied population was 7 (5–9). The median of each center is shown in the figure. Centers were divided into two groups based on their median LOS value. Centers with a LOS median lower than 7 days constituted the “short” LOS centers group and centers with a LOS median of 7 days or higher constituted the “long” LOS centers group. The short LOS group (13 centers, 1559 patients) had a median LOS of 5 (4–7) days and the long LOS group (35 centers, 4298 patients) had a median LOS of 8 (6–10) days. There was no difference in baseline characteristics of patients between the two groups except for logistic EuroSCORE significantly lower in the short LOS group (15.5 ± 10.5 vs. 17.1 ± 11.0%, P < 0.001). General anesthesia (48.0 vs. 26.9%, P < 0.001) and self-expandable prosthesis (33.2 vs. 24.6%, P < 0.001) were more frequently used in the long LOS group. Acute kidney injury stage 2–3 (2.5 vs. 1.5%, P = 0.03) and conductive disorders requiring pacemaker (15.3 vs.11.4%, P < 0.001) were more frequent in the long group. LOS remains high after TF TAVI in France and extremely variable among centers. Centers with a longer LOS more frequently used self-expandable prosthesis and general anesthesia with a higher rate of pacemaker.