Sandra B Lauck1, Janarthanan Sathananthan1, Julie Park2, Leslie Achtem1, Amanda Smith3, Patricia Keegan4, Marian Hawkey5, Russell Brandwein5, John G Webb1, David A Wood1. 1. Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 2. BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada. 3. Cardiac Program, Hamilton Health Sciences, Hamilton, Ontario, Canada. 4. Structural Heart Program, Emory University, Atlanta, Georgia. 5. Cardiac Program, Columbia University, New York, New York.
Abstract
BACKGROUND: Evidence is lacking to standardize post-procedure care after transcatheter aortic valve replacement (TAVR). OBJECTIVE: We report on the findings of the post-procedure sub-study of the multimodality, multidisciplinary but minimalist TAVR (3M TAVR) study. METHODS: A standardized protocol to guide monitoring, early mobilization, reconditioning, communication, and criteria-driven discharge was implemented in a multicenter, prospective, sequential case series study in 13 North American low, medium, and high-volume centers in 2015-2017. Outcome measures pertaining to post-procedure care included avoidance of invasive lines and delirium, in-hospital bed utilization, patient disposition at the time of discharge, and 30-day use of nonelective medical services. RESULTS: Four hundred eleven participants were enrolled. In the post-procedure phase, 365 (88.8%) participants were admitted without a temporary pacemaker; urinary catheterization was avoided in 402 (97.8%) participants. Of note, 91.7% received care in a single unit (critical care: 72.5%; cardiac telemetry: 19.2%); 99.0% were discharged home. At the time of 30-day follow-up, 6 (1.6%) participants required admission to a rehabilitation or a skilled nursing facility; 30-day emergency department visits were 13.5%. CONCLUSIONS: The implementation of the 3M TAVR standardized accelerated reconditioning protocol is a safe and effective strategy to facilitate next-day discharge home after TAVR in centers of varying size.
BACKGROUND: Evidence is lacking to standardize post-procedure care after transcatheter aortic valve replacement (TAVR). OBJECTIVE: We report on the findings of the post-procedure sub-study of the multimodality, multidisciplinary but minimalist TAVR (3M TAVR) study. METHODS: A standardized protocol to guide monitoring, early mobilization, reconditioning, communication, and criteria-driven discharge was implemented in a multicenter, prospective, sequential case series study in 13 North American low, medium, and high-volume centers in 2015-2017. Outcome measures pertaining to post-procedure care included avoidance of invasive lines and delirium, in-hospital bed utilization, patient disposition at the time of discharge, and 30-day use of nonelective medical services. RESULTS: Four hundred eleven participants were enrolled. In the post-procedure phase, 365 (88.8%) participants were admitted without a temporary pacemaker; urinary catheterization was avoided in 402 (97.8%) participants. Of note, 91.7% received care in a single unit (critical care: 72.5%; cardiac telemetry: 19.2%); 99.0% were discharged home. At the time of 30-day follow-up, 6 (1.6%) participants required admission to a rehabilitation or a skilled nursing facility; 30-day emergency department visits were 13.5%. CONCLUSIONS: The implementation of the 3M TAVR standardized accelerated reconditioning protocol is a safe and effective strategy to facilitate next-day discharge home after TAVR in centers of varying size.
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: Andrei M Pop; Madeleine Barker; Lynn Hickman; Firas Barrow; Janarthanan Sathananthan; William Stansfield; Michael Nikolov; Elsayed Mohamed; Sandra Lauck; Jia Wang; John G Webb; David A Wood Journal: Struct Heart Date: 2022-03-21