Is the outcome of elective vs non-elective patients undergoing transcatheter aortic valve implantation different? Results of a single-centre, observational assessment of outcomes at a large university clinic

BMC Cardiovascular Disorders

Research

David A. Wood¹  Janarthanan Sathananthan¹  Sandra B. Lauck²  Georg Lutter³  Thomas Puehler³  Johannes C. Dümmler⁴  Mohammed Saad⁵  Lukas Ritter⁵  Steffen Wundram⁵  Matthias Lutz⁶  Hatim Seoudy⁶  Derk Frank⁶  Johanne Frank⁶  Peter Bramlage⁷  Norbert Frey⁸ 

[1] Centre for Cardiovascular Innovation – Centre d’Innovation Cardiovasculaire, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada;Centre for Cardiovascular Innovation – Centre d’Innovation Cardiovasculaire, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada;School of Nursing, University of British Columbia, Vancouver, Canada;DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany;Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany;Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany;Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105, Kiel, Germany;Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105, Kiel, Germany;DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany;Institute for Pharmacology and Preventive Medicine, Bahnhofstrasse 20, 49661, Cloppenburg, Germany;University Hospital of Heidelberg, Cardiology, , Heidelberg, Germany;DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany;

关键词: Transcatheter aortic valve implantation;    Aortic stenosis;    Fast-track;    Coordinator;    Patient care;   

DOI  :  10.1186/s12872-023-03317-5

 received in 2022-10-18, accepted in 2023-05-22,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundTranscatheter aortic valve implantation (TAVI) can either be conducted as an elective (scheduled in advance) or a non-elective procedure performed during an unplanned hospital admission. The objective of this study was to compare the outcomes of elective and non-elective TAVI patients.MethodsThis single-centre study included 512 patients undergoing transfemoral TAVI between October 2018 and December 2020; 378 (73.8%) were admitted for elective TAVI, 134 (26.2%) underwent a non-elective procedure. Our TAVI programme entails an optimized fast-track concept aimed at minimizing the total length of stay to ≤ 5 days for elective patients which in the German healthcare system is currently defined as the minimal time period to safely perform TAVI. Clinical characteristics and survival rates at 30 days and 1 year were analysed.ResultsPatients who underwent non-elective TAVI had a significantly higher comorbidity burden. Median duration from admission to discharge was 6 days (elective group 6 days versus non-elective group 15 days; p < 0.001), including a median postprocedural stay of 5 days (elective 4 days versus non-elective 7 days; p < 0.001). All-cause mortality at 30 days was 1.1% for the elective group and 3.7% for non-elective patients (p = 0.030). At 1 year, all-cause mortality among elective TAVI patients was disproportionately lower than in non-elective patients (5.0% versus 18.7%, p < 0.001). In the elective group, 54.5% of patients could not be discharged early due to comorbidities or procedural complications. Factors associated with a failure of achieving a total length of stay of ≤ 5 days comprised frailty syndrome, renal impairment as well as new permanent pacemaker implantation, new bundle branch block or atrial fibrillation, life-threatening bleeding, and the use of self-expanding valves. After multivariate adjustment, new permanent pacemaker implantation (odds ratio 6.44; 95% CI 2.59–16.00), life-threatening bleeding (odds ratio 4.19; 95% confidence interval 1.82–9.66) and frailty syndrome (odds ratio 5.15; 95% confidence interval 2.40–11.09; all p < 0.001, respectively) were confirmed as significant factors.ConclusionsWhile non-elective patients had acceptable periprocedural outcomes, mortality rates at 1 year were significantly higher compared to elective patients. Approximately only half of elective patients could be discharged early. Improvements in periprocedural care, follow-up strategies and optimized treatment of both elective and non-elective TAVI patients are needed.

【 授权许可】

CC BY   
© The Author(s) 2023

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