Next-Day Discharge After Transcatheter Aortic Valve Implantation With the ACURATE neo/neo2 Self-Expanding Aortic Bioprosthesis

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Prior studies have shown the safety of early discharge (ED) pathways in selected patients and using selected transcatheter heart valves. Hence, we sought to evaluate the safety of next-day discharge (NDD) in patients who underwent transfemoral transcatheter aortic valve implantation (TF-TAVI) with the Acurate neo/neo2 (Boston Scientific, Marlborough, MA) self-expanding aortic bioprosthesis. Patients who underwent TF-TAVI between January 2018 and April 2023 were prospectively included. Patients were stratified into 3 groups according to discharge times within 24h (NDD), between 24-48h and those discharged >48h following TAVI. The primary outcome was the first unplanned readmission at 30 days after TAVI. Log-rank test was used to assess differences in the outcome of interest among groups. A total of 368 allcomers were included in this study. According to discharge times, 204 patients followed NDD, 69 patients 24-48h discharge and 95 patients >48h discharge following TAVI. The mean age was 84±6.3 years and 61% were female, without differences between groups. The mean STS-score was lower among those with NDD versus 24-48h and >48h (2.9±1.0, 3.2±1.2 and 3.4±1.4, respectively, P=0.014). There were no differences between the groups in terms of preprocedural right bundle branch block or pacemaker. The need for new permanent pacemaker implantation (PPI) was the leading postprocedural complication; it occurred more frequently among the >48h group compared with the 24-48h and <24h groups (24% versus 8.6% and 2.2%, P<0.001). There were 5 (1.4%) strokes and all of them occurred in the >48h group (P=0.005). At 30 days after discharge, there were no deaths, and no differences in all-cause readmissions (9.3% in <24h, 8.6% in 24-48h, and 19% in >48h, log-rank P=0.087). Readmission rates for new PPI requirement were 3.3% (n=6) in NDD, 0% in 24-48h and 1.6% (n=5) in >48h groups (P=0.27). In conclusion, in unselected patients undergoing TF-TAVI with the Acurate neo/neo2 self-expanding bioprosthesis, the NDD pathway is feasible and appears to be safe, without an increased risk of death or all-cause rehospitalization through 30 days after hospital discharge.