Predictors for non-delayed discharge after transcatheter aortic valve replacement: utility of echocardiographic parameters.

Abstract

Considering that transcatheter aortic valve replacement (TAVR) procedures have become less invasive, the duration for monitoring patient care after a successful TAVR can be reduced. Therefore, this study aimed to investigate the prognostic value of baseline echocardiographic parameters for non-delayed discharge in patients after TAVR. The study group included 154 consecutive patients (mean age: 84.4±4.5years; and 101 women) who underwent a TAVR. Comprehensive echocardiograms including both side indices of myocardial performance (IMP) and blood tests were obtained prior to the TAVR procedure. The median post-TAVR length of stay was 6days while the mode and first quartile were both 4days. Receiver operating characteristic curve analysis showed that the optimum cut-off value of the left-sided IMP in patients with a normal left ventricular ejection fraction (LVEF,≥50%) (n=124) for non-delayed discharge (≤4days) was 0.34 with an area under the curve (AUC) value of 0.71563 and p value of<0.0001, while the optimum cut-off value in patients with reduced LVEF (<50%) (n=30) was 0.47 with an AUC value of 0.77778 and p value of<0.0120. An adjusted analysis indicated the negative left-sided IMP results as the only predictor for non-delayed discharge (p<0.0001). Furthermore, the adjusted predictors for survival without early cardiovascular re-hospitalization within 6months after TAVR were the positive left-sided IMP result, when the cut-off value of 0.52 was used, and the presence of elevated RAP of 8 to 15mmHg. The early discharge policy should be carefully considered in high-risk populations, but the left-sided IMP may play a significant role in the pre-screening process.