Feasibility of same-day discharge after transcatheter aortic valve replacement: the North Shore Day Stay pathway

Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe symptomatic aortic stenosis but expanding indications have increased strain on hospital resources. Several studies assessed same-day discharge (SDD) after TAVR during the COVID-19 pandemic and showed it to be safe in well-selected, low-risk patients. However, more studies are warranted, with no studies in an Australian population and minimal data on self-expanding valves. Patients undergoing consecutive, transfemoral TAVR procedures at two large-volume centres in Sydney, Australia between 2021 and 2023 were prospectively recruited to the CONDUCT-TAVI study cohort. A locally derived clinical pathway ('The North Shore Pathway') was retrospectively applied to identify which patients would have been suitable for SDD. In-hospital and 30-day outcomes were compared between SDD patients and the remaining, ineligible patients (standard discharge cohort). Of 182 patients, 20 (11.0%) met SDD criteria. The total cohort received both self-expanding (67.3%) and balloon-expandable valves (32.7%). The SDD cohort had a higher proportion of females (55.0% vs. 21.5%, p = 0.04) but was otherwise comparable in baseline and procedural characteristics. No significant differences were found in hospital or 30-day outcomes. One SDD patient was readmitted with complete heart block requiring pacemaker implantation (day 20), and two patients had non-cardiovascular readmissions. No other adverse outcomes occurred in the SDD cohort. The present study suggests SDD after TAVR is feasible in both balloon-expandable and self-expanding cohorts. The study also supports prospective validation of the North Shore Day Stay pathway as a tool to safely identify low-risk patients that are suitable for SDD after TAVR.