• Yasuhiro Ichibori, Jun Li, Angela Davis, Toral M Patel, Jerry Lipinski, Muhammad Panhwar, Petar Saric, Ghazanfar Qureshi, Sandeep M Patel, Basar Sareyyupoglu, Alan H Markowitz, Hiram G Bezerra, Marco A Costa, David A Zidar, Ankur Kalra, and Guilherme F Attizzani.
• Division of Cardiovascular Medicine University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106 USA. yasuhiro11ichibom@gmail.com.
• J Invasive Cardiol. 2019 Mar 1; 31 (3): 64-72.

ObjectivesData on next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR) are limited. This study investigated the feasibility and safety of NDD as a first-line option (the very-early discharge [VED] strategy) compared with the early-discharge (ED) strategy (2-3 days as a first-line option) after TAVR.MethodsWe reviewed 611 consecutive patients who had minimalist TAVR (transfemoral approach under conscious sedation) and no in-hospital mortality; a total of 418 patients underwent ED strategy (since December 2013) and 193 patients underwent VED strategy (as part of a hospital initiative to reduce length of stay, since August 2016). NDD in the VED strategy was performed with heart team consensus in patients without significant complications. The primary outcome was a composite of 30-day all-cause mortality/rehospitalization.ResultsSixty-five patients (33.7%) in the VED strategy and 10 patients (2.4%) in the ED strategy were discharged the next day (P<.001). NDD patients had received balloon-expandable (n = 30) or self-expanding valves (n = 45) and showed a similar primary outcome rate compared with non-NDD patients. After adjustment using propensity score matching (172 pairs), post-TAVR length of stay was significantly shorter in the VED group (3.2 ± 3.1 days) than in the ED group (3.5 ± 2.7 days; P<.01). The primary outcome did not differ between the two groups (7.0% vs 11.6%; P=.14), with comparable 30-day mortality rate (1.2% vs 2.3%; P=.68) and rehospitalization rate (5.8% vs 11.1%; P=.08).ConclusionsUtilization of NDD as a first-line option after minimalist TAVR is feasible and safe, and leads to further reduction in length of stay compared with an ED strategy.

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