OBJECTIVES: The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway. BACKGROUND: Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, hospital stays average at least 6 days in most trials. The Vancouver 3M Clinical Pathway is focused on next-day discharge, made possible by the use of objective screening criteria as well as streamlined peri- and post-procedural management guidelines. METHODS: Patients were enrolled from 6 low-volume (<100 TAVR/year), 4 medium-volume, and 3 high-volume (>200 TAVR/year) centers in Canada and the United States. The primary outcomes were a composite of all-cause death or stroke by 30 days and the proportion of patients successfully discharged home the day following TAVR. RESULTS: Of 1,400 screened patients, 411 were enrolled at 13 centers and received a SAPIEN XT (58.2%) or SAPIEN 3 (41.8%) valve (Edwards Lifesciences, Irvine, California). In centers enrolling exclusively in the study, 55% of screened patients were enrolled. The median age was 84 years (interquartile range: 78 to 87 years) with a median STS score of 4.9% (interquartile range: 3.3% to 6.8%). Next-day discharge home was achieved in 80.1% of patients, and within 48 h in 89.5%. The composite of all-cause mortality or stroke by 30 days occurred in 2.9% (95% confidence interval: 1.7% to 5.1%), with neither component of the primary outcome affected by hospital TAVR volume (p = 0.51). Secondary outcomes at 30 days included major vascular complication 2.4% (n = 10), readmission 9.2% (n = 36), cardiac readmission 5.7% (n = 22), new permanent pacemaker 5.7% (n = 23), and >mild paravalvular regurgitation 3.8% (n = 15). CONCLUSIONS: Adherence to the Vancouver 3M Clinical Pathway at low-, medium-, and high-volume TAVR centers allows next-day discharge home with excellent safety and efficacy outcomes.
OBJECTIVES: The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway. BACKGROUND: Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, hospital stays average at least 6 days in most trials. The Vancouver 3M Clinical Pathway is focused on next-day discharge, made possible by the use of objective screening criteria as well as streamlined peri- and post-procedural management guidelines. METHODS:Patients were enrolled from 6 low-volume (<100 TAVR/year), 4 medium-volume, and 3 high-volume (>200 TAVR/year) centers in Canada and the United States. The primary outcomes were a composite of all-cause death or stroke by 30 days and the proportion of patients successfully discharged home the day following TAVR. RESULTS: Of 1,400 screened patients, 411 were enrolled at 13 centers and received a SAPIEN XT (58.2%) or SAPIEN 3 (41.8%) valve (Edwards Lifesciences, Irvine, California). In centers enrolling exclusively in the study, 55% of screened patients were enrolled. The median age was 84 years (interquartile range: 78 to 87 years) with a median STS score of 4.9% (interquartile range: 3.3% to 6.8%). Next-day discharge home was achieved in 80.1% of patients, and within 48 h in 89.5%. The composite of all-cause mortality or stroke by 30 days occurred in 2.9% (95% confidence interval: 1.7% to 5.1%), with neither component of the primary outcome affected by hospital TAVR volume (p = 0.51). Secondary outcomes at 30 days included major vascular complication 2.4% (n = 10), readmission 9.2% (n = 36), cardiac readmission 5.7% (n = 22), new permanent pacemaker 5.7% (n = 23), and >mild paravalvular regurgitation 3.8% (n = 15). CONCLUSIONS: Adherence to the Vancouver 3M Clinical Pathway at low-, medium-, and high-volume TAVR centers allows next-day discharge home with excellent safety and efficacy outcomes.
Authors: Neel M Butala; Mabel Chung; Eric A Secemsky; Pratik Manandhar; Guillaume Marquis-Gravel; Andrzej S Kosinski; Sreekanth Vemulapalli; Robert W Yeh; David J Cohen Journal: JACC Cardiovasc Interv Date: 2020-06-08 Impact factor: 11.195
Authors: Ali O Malik; Adnan K Chhatriwalla; John Saxon; Vittal Hejjaji; Amanda Stebbins; Philip G Jones; David J Cohen; Suzanne V Arnold; Sreekanth Vemulapalli; Zachary K Wegermann; Andrzej Kosinski; John A Spertus Journal: Circ Cardiovasc Qual Outcomes Date: 2020-12-07
Authors: Florence Leclercq; Pierre Alain Meunier; Thomas Gandet; Jean-Christophe Macia; Delphine Delseny; Philippe Gaudard; Marc Mourad; Laurent Schmutz; Pierre Robert; François Roubille; Guillaume Cayla; Mariama Akodad Journal: J Clin Med Date: 2022-05-16 Impact factor: 4.964
Authors: Neel M Butala; David A Wood; Haiyan Li; Khaja Chinnakondepalli; Sandra B Lauck; Janarthanan Sathananthan; John A Cairns; Elizabeth A Magnuson; Madeleine Barker; John G Webb; Robert Welsh; Anson Cheung; Jian Ye; James L Velianou; Harindra C Wijeysundera; Anita Asgar; Susheel Kodali; Vinod H Thourani; David J Cohen Journal: Circ Cardiovasc Interv Date: 2022-10-18 Impact factor: 7.514
Authors: Herbert G Kroon; Pim A L Tonino; Mikko Savontaus; Giovanni Amoroso; Mika Laine; Evald H Christiansen; Stefan Toggweiler; Jur Ten Berg; Janarthanan Sathananthan; Joost Daemen; Peter P de Jaegere; Guus B R G Brueren; Markus Malmberg; Ton Slagboom; Noriaki Moriyama; Christian J Terkelsen; Federico Moccetti; Livia Gheorghe; John Webb; David Wood; Nicolas M Van Mieghem Journal: Catheter Cardiovasc Interv Date: 2020-12-21 Impact factor: 2.692
Authors: J Vendrik; J de Boer; W Zwiers; S A van Gilst; M Holierook; E V Chekanova; J S Henriques; J Baan Journal: Neth Heart J Date: 2020-07 Impact factor: 2.380