• Julinda Mehilli, Jaya Chandrasekhar, Samantha Sartori, Alaide Chieffo, Anna S Petronio, Thierry Lefèvre, Patrizia Presbitero, Piera Capranzano, Didier Tchetche, Alessandro Iadanza, Gennaro Sardella, Nicolas M Van Mieghem, Emanuela Meliga, Nicolas Dumonteil, Chiara Fraccaro, Daniela Trabattoni, David Jochheim, Magda Zadrozny, Ghada W Mikhail, Samin Sharma, Maria C Ferrer, Christoph Naber, Peter Kievit, Kamilia Moalem, Usman Baber, Clayton Snyder, Madhav Sharma, Marie C Morice, Roxana Mehran, and Women’s INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) Investigators.
• Munich University Clinic, Ludwig-Maximilians-University and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.
• Can J Cardiol. 2019 Feb 1; 35 (2): 199-207.

BackgroundSeveral clinical and procedural factors determine outcomes after transcatheter aortic valve replacement (TAVR), but data are scarce on the impact of post-TAVR discharge disposition on long-term outcomes. We sought to analyse whether discharge location after TAVR is associated with 1-year outcomes in women undergoing contemporary TAVR.MethodsThe Women's INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) registry is the first all-female TAVR registry to study the safety and performance of contemporary TAVR in women (n = 1019). Information on discharge location was available in 817 patients (80.2%). We compared women discharged home vs those discharged to another location (nursing home, rehabilitation, or other hospital). One-year outcomes were adjusted using multivariable Cox regression methods with discharge home as the reference group.ResultsOf the study subjects, 75.2% (n = 614) were discharged home and 24.8% (n = 203) to another location. Women discharged to other locations were older with a greater prevalence of severe lung disease requiring home oxygen and renal failure on dialysis but were less frequently considered frail or at high surgical risk compared with women discharged home. After multivariable adjustment, non-home discharge was associated with greater hazard for 1-year Valve Academic Research Consortium 2 efficacy (21.3% vs 10.8%, hazards ratio [HR] 1.9, 95% confidence interval [CI] 1.2-2.9) and safety endpoints (31.5% vs 15.2%, HR 2.1, 95% CI 1.5-3.0), cardiovascular death (12.7% vs 5.5%, HR 2.0, 95% CI 1.1-3.6), and stroke (6.5% vs 0.8%, HR 8.5, 95% CI 2.9-25.6).ConclusionsIn women undergoing contemporary TAVR, discharge disposition significantly affects 1-year risk of outcomes even after adjustment for recorded baseline differences. This might suggest the necessity of considering additional factors beyond comorbidities in the TAVR decision-making process.Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

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