Research progress on early discharge of patients after transcatheter aortic valve replacement_West China Medical Journal

Authors：

HUANG Cen ¹ ,  LI Lingli ² , ZHENG Mingxia ³ , CUI Qinghua ⁴ , CHEN Hong ⁴

1. West China School of Nursing, Sichuan University / Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Nursing, Sichuan University / Nursing Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Lingli, Email: lilingli2000@126.com

Keywords：

Transcatheter aortic valve replacement; early discharge; research progress

DOI：

10.7507/1002-0179.202507139

Video：

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Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for aortic valve stenosis. Clinical practice reduces the length of hospital stay of patients and promotes their early safe discharge home by adopting minimalist approach TAVR and standardized postoperative care. Foreign studies have shown that early discharge from hospital is safe and feasible, which can reduce medical costs and complications, but there are few relevant research in China. This article mainly reviews the assessment, influencing factors, and management strategies to promote early discharge of patients after TAVR, with the aim of providing references for the early discharge management practice of medical staff.

1.	刘新民, 王墨扬. 中国经导管主动脉瓣置换术临床路径专家共识 (2024 版). 中国循环杂志, 2024, 39(11): 1041-1057.
2.	Siontis GCM, Overtchouk P, Cahill TJ, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis. Eur Heart J, 2019, 40(38): 3143-3153.
3.	Davidson LJ, Davidson CJ. Transcatheter treatment of valvular heart disease: a review. JAMA, 2021, 325(24): 2480-2494.
4.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement in low-risk patients at five years. N Engl J Med, 2023, 389(21): 1949-1960.
5.	经导管主动脉瓣置换术流程优化共识专家组. 经导管主动脉置换术 (TAVR) 流程优化专家共识 2022 版. 中华急诊医学杂志, 2022, 31(2): 154-160.
6.	Lauck SB, Wood DA, Achtem L, et al. Risk stratification and clinical pathways to optimize length of stay after transcatheter aortic valve replacement. Can J Cardiol, 2014, 30(12): 1583-1587.
7.	Wood DA, Lauck SB, Cairns JA, et al. The vancouver 3M (multidisciplinary, multimodality, but minimalist) clinical pathway facilitates safe next-day discharge home at low-, medium-, and high-volume transfemoral transcatheter aortic valve replacement centers: the 3M TAVR Study. JACC Cardiovasc Interv, 2019, 12(5): 459-469.
8.	Barbanti M, van Mourik MS, Spence MS, et al. Optimising patient discharge management after transfemoral transcatheter aortic valve implantation: the multicentre European FAST-TAVI trial. EuroIntervention, 2019, 15(2): 147-154.
9.	Durand E, Beziau-Gasnier D, Michel M, et al. Reducing length of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial. Eur Heart J, 2024, 45(11): 952-962.
10.	Babaliaros V, Devireddy C, Lerakis S, et al. Comparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): outcomes and cost analysis. JACC Cardiovasc Interv, 2014, 7(8): 898-904.
11.	Lauck SB, Wood DA, Baumbusch J, et al. Vancouver transcatheter aortic valve replacement clinical pathway: minimalist approach, standardized care, and discharge criteria to reduce length of stay. Circ Cardiovasc Qual Outcomes, 2016, 9(3): 312-321.
12.	Barbanti M, Baan J, Spence MS, et al. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation-rationale and design of the FAST-TAVI registry. BMC Cardiovasc Disord, 2017, 17(1): 259.
13.	Krishnaswamy A, Isogai T, Agrawal A, et al. Feasibility and safety of same-day discharge following transfemoral transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2022, 15(6): 575-589.
14.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
15.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
16.	Barbanti M, Capranzano P, Ohno Y, et al. Early discharge after transfemoral transcatheter aortic valve implantation. Heart, 2015, 101(18): 1485-1490.
17.	Kamioka N, Wells J, Keegan P, et al. Predictors and clinical outcomes of next-day discharge after minimalist transfemoral transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2018, 11(2): 107-115.
18.	Durand E, Avinée G, Gillibert A, et al. Analysis of length of stay after transfemoral transcatheter aortic valve replacement: results from the FRANCE TAVI registry. Clin Res Cardiol, 2021, 110(1): 40-49.
19.	Aldalati O, Keshavarzi F, Kaura A, et al. Factors associated with safe early discharge after transcatheter aortic valve implantation. Cardiol J, 2018, 25(1): 14-23.
20.	Angelillis M, Costa G, Giannini C, et al. Predictors of early discharge after transcatheter aortic valve implantation: insight from the CoreValve ClinicalService. J Cardiovasc Med (Hagerstown), 2022, 23(7): 454-462.
21.	Didier R, Le Breton H, Eltchaninoff H, et al. Evolution of TAVI patients and techniques over the past decade: the French TAVI registries. Arch Cardiovasc Dis, 2022, 115(4): 206-213.
22.	Ooms JF, Cornelis K, Wijeysundera HC, et al. Safety and feasibility of early discharge after transcatheter aortic valve implantation with ACURATE Neo-the POLESTAR trial. Clin Res Cardiol, 2025, 114(3): 341-349.
23.	Lilly SM, Deshmukh AJ, Epstein AE, et al. 2020 ACC expert consensus decision pathway on management of conduction disturbances in patients undergoing transcatheter aortic valve replacement: a report of the American college of cardiology solution set oversight committee. J Am Coll Cardiol, 2020, 76(20): 2391-2411.
24.	Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J, 2021, 42(35): 3427-3520.
25.	Vemulapalli S, Carroll JD, Mack MJ, et al. Procedural volume and outcomes for transcatheter aortic-valve replacement. N Engl J Med, 2019, 380(26): 2541-2550.
26.	Carroll JD, Vemulapalli S, Dai D, et al. Procedural experience for transcatheter aortic valve replacement and relation to outcomes: the STS/ACC TVT registry. J Am Coll Cardiol, 2017, 70(1): 29-41.
27.	Thiele H, Kurz T, Feistritzer HJ, et al. General versus local anesthesia with conscious sedation in transcatheter aortic valve implantation: the randomized SOLVE-TAVI Trial. Circulation, 2020, 142(15): 1437-1447.
28.	赵振燕, 张洪亮, 张喆, 等. 在单纯局部麻醉下行经导管主动脉瓣置换术可行性和安全性的初步研究. 中国循环杂志, 2022, 37(4): 341-347.
29.	Faurie B, Abdellaoui M, Wautot F, et al. Rapid pacing using the left ventricular guidewire: reviving an old technique to simplify BAV and TAVI procedures. Catheter Cardiovasc Interv, 2016, 88(6): 988-993.
30.	刘新民, 宋光远, 滕思勇, 等. 使用左心室导丝起搏技术行经导管主动脉瓣置换术联合经皮冠状动脉介入治疗一站式手术一例. 中国循环杂志, 2020, 35(12): 1250-1252.
31.	Hensey M, Sathananthan J, Alkhodair A, et al. Single-center prospective study examining use of the Wattson temporary pacing guidewire for transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2020, 96(4): 968-971.
32.	Regueiro A, Alperi A, Vilalta V, et al. Safety and efficacy of TAVR with a pressure sensor and pacing guidewire: SAFE-TAVI trial. JACC Cardiovasc Interv, 2023, 16(24): 3016-3023.
33.	Aurigemma C, Trani C, D'Errigo P, et al. Impact of vascular complications after transcatheter aortic valve implantation. VASC-OBSERVANT II sub-study. Catheter Cardiovasc Interv, 2023, 102(2): 381-391.
34.	Vierhout BP, Pol RA, El Moumni M, et al. Editor’s choice - arteriotomy closure devices in EVAR, TEVAR, and TAVR: a systematic review and meta-analysis of randomised clinical trials and cohort studies. Eur J Vasc Endovasc Surg, 2017, 54(1): 104-115.
35.	Fernandez-Lopez L, Chevalier B, Lefèvre T, et al. Implementation of the transradial approach as an alternative vascular access for transcatheter aortic valve replacement guidance: Experience froma high-volume center. Catheter Cardiovasc Interv, 2019, 93(7): 1367-1373.
36.	Lauck SB, Kwon JY, Wood DA, et al. Avoidance of urinary catheterization to minimize in-hospital complications after transcatheter aortic valve implantation: an observational study. Eur J Cardiovasc Nurs, 2018, 17(1): 66-74.
37.	Szerlip M, Tabachnick D, Hamandi M, et al. Safe implementation of enhanced recovery after surgery protocol in transfemoral transcatheter aortic valve replacement. Proc (Bayl Univ Med Cent), 2020, 34(1): 5-10.
38.	Lauck SB, Yu M, Bancroft C, et al. Early mobilization after transcatheter aortic valve implantation: observational cohort study. Eur J Cardiovasc Nurs, 2024, 23(3): 296-304.
39.	Lauck S, Sathananthan J, Achtem L, et al. Nurse-led post-procedure protocol to facilitate safe next-day discharge home: findings of the 3M tavr study. Can J Cardiol, 2019, 35(10): S204.
40.	Worthington KP, Giannantonio E. Implementing a nurse-driven early ambulation protocol to enhance post-transcatheter aortic valve replacement outcomes: a quality improvement initiative. J Nurs Care Qual, 2025, 40(2): 187-192.
41.	Hart L, Frankel R, Crooke G, et al. Promoting early mobility in patients after transcatheter aortic valve replacement: an evidence-based protocol. Crit Care Nurse, 2021, 41(5): e9-e16.
42.	Cusin CN, Clark PA, Lauderbach CW Jr. , et al. Reducing length of stay for patients undergoing transcatheter aortic valve replacement using a prescreening approach. J Am Assoc Nurse Pract, 2022, 34(6): 844-849.
43.	McCalmont G, Durand E, Lauck S, et al. Setting a benchmark for resource utilization and quality of care in patients undergoing transcatheter aortic valve implantation in Europe-Rationale and design of the international BENCHMARK registry. Clin Cardiol, 2021, 44(10): 1344-1353.
44.	毛越, 徐剑锋, 李梅, 等. 经导管主动脉瓣置换术患者Ⅰ期心脏康复的最佳证据应用. 中华护理杂志, 2022, 57(5): 563-569.
45.	Murali S, Brugger N, Rincon F, et al. Cardiac ambulatory monitoring: new wireless device validated against conventional holter monitoring in a case series. Front Cardiovasc Med, 2020, 7: 587945.
46.	Yenikomshian M, Jarvis J, Patton C, et al. Cardiac arrhythmia detection outcomes among patients monitored with the Zio patch system: a systematic literature review. Curr Med Res Opin, 2019, 35(10): 1659-1670.
47.	Natarajan MK, Sheth TN, Wijeysundera HC, et al. Remote ECG monitoring to reduce complications following transcatheter aortic valve implantations: the redirect TAVI study. Europace, 2022, 24(9): 1475-1483.
48.	郑蓉蓉, 戴晗怡, 周道, 等. 智能手表在经导管主动脉瓣置换术后患者中应用三例. 中国循环杂志, 2023, 38(10): 1083-1086.

1. 刘新民, 王墨扬. 中国经导管主动脉瓣置换术临床路径专家共识 (2024 版). 中国循环杂志, 2024, 39(11): 1041-1057.
2. Siontis GCM, Overtchouk P, Cahill TJ, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis. Eur Heart J, 2019, 40(38): 3143-3153.
3. Davidson LJ, Davidson CJ. Transcatheter treatment of valvular heart disease: a review. JAMA, 2021, 325(24): 2480-2494.
4. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement in low-risk patients at five years. N Engl J Med, 2023, 389(21): 1949-1960.
5. 经导管主动脉瓣置换术流程优化共识专家组. 经导管主动脉置换术 (TAVR) 流程优化专家共识 2022 版. 中华急诊医学杂志, 2022, 31(2): 154-160.
6. Lauck SB, Wood DA, Achtem L, et al. Risk stratification and clinical pathways to optimize length of stay after transcatheter aortic valve replacement. Can J Cardiol, 2014, 30(12): 1583-1587.
7. Wood DA, Lauck SB, Cairns JA, et al. The vancouver 3M (multidisciplinary, multimodality, but minimalist) clinical pathway facilitates safe next-day discharge home at low-, medium-, and high-volume transfemoral transcatheter aortic valve replacement centers: the 3M TAVR Study. JACC Cardiovasc Interv, 2019, 12(5): 459-469.
8. Barbanti M, van Mourik MS, Spence MS, et al. Optimising patient discharge management after transfemoral transcatheter aortic valve implantation: the multicentre European FAST-TAVI trial. EuroIntervention, 2019, 15(2): 147-154.
9. Durand E, Beziau-Gasnier D, Michel M, et al. Reducing length of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial. Eur Heart J, 2024, 45(11): 952-962.
10. Babaliaros V, Devireddy C, Lerakis S, et al. Comparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): outcomes and cost analysis. JACC Cardiovasc Interv, 2014, 7(8): 898-904.
11. Lauck SB, Wood DA, Baumbusch J, et al. Vancouver transcatheter aortic valve replacement clinical pathway: minimalist approach, standardized care, and discharge criteria to reduce length of stay. Circ Cardiovasc Qual Outcomes, 2016, 9(3): 312-321.
12. Barbanti M, Baan J, Spence MS, et al. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation-rationale and design of the FAST-TAVI registry. BMC Cardiovasc Disord, 2017, 17(1): 259.
13. Krishnaswamy A, Isogai T, Agrawal A, et al. Feasibility and safety of same-day discharge following transfemoral transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2022, 15(6): 575-589.
14. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
15. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
16. Barbanti M, Capranzano P, Ohno Y, et al. Early discharge after transfemoral transcatheter aortic valve implantation. Heart, 2015, 101(18): 1485-1490.
17. Kamioka N, Wells J, Keegan P, et al. Predictors and clinical outcomes of next-day discharge after minimalist transfemoral transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2018, 11(2): 107-115.
18. Durand E, Avinée G, Gillibert A, et al. Analysis of length of stay after transfemoral transcatheter aortic valve replacement: results from the FRANCE TAVI registry. Clin Res Cardiol, 2021, 110(1): 40-49.
19. Aldalati O, Keshavarzi F, Kaura A, et al. Factors associated with safe early discharge after transcatheter aortic valve implantation. Cardiol J, 2018, 25(1): 14-23.
20. Angelillis M, Costa G, Giannini C, et al. Predictors of early discharge after transcatheter aortic valve implantation: insight from the CoreValve ClinicalService. J Cardiovasc Med (Hagerstown), 2022, 23(7): 454-462.
21. Didier R, Le Breton H, Eltchaninoff H, et al. Evolution of TAVI patients and techniques over the past decade: the French TAVI registries. Arch Cardiovasc Dis, 2022, 115(4): 206-213.
22. Ooms JF, Cornelis K, Wijeysundera HC, et al. Safety and feasibility of early discharge after transcatheter aortic valve implantation with ACURATE Neo-the POLESTAR trial. Clin Res Cardiol, 2025, 114(3): 341-349.
23. Lilly SM, Deshmukh AJ, Epstein AE, et al. 2020 ACC expert consensus decision pathway on management of conduction disturbances in patients undergoing transcatheter aortic valve replacement: a report of the American college of cardiology solution set oversight committee. J Am Coll Cardiol, 2020, 76(20): 2391-2411.
24. Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J, 2021, 42(35): 3427-3520.
25. Vemulapalli S, Carroll JD, Mack MJ, et al. Procedural volume and outcomes for transcatheter aortic-valve replacement. N Engl J Med, 2019, 380(26): 2541-2550.
26. Carroll JD, Vemulapalli S, Dai D, et al. Procedural experience for transcatheter aortic valve replacement and relation to outcomes: the STS/ACC TVT registry. J Am Coll Cardiol, 2017, 70(1): 29-41.
27. Thiele H, Kurz T, Feistritzer HJ, et al. General versus local anesthesia with conscious sedation in transcatheter aortic valve implantation: the randomized SOLVE-TAVI Trial. Circulation, 2020, 142(15): 1437-1447.
28. 赵振燕, 张洪亮, 张喆, 等. 在单纯局部麻醉下行经导管主动脉瓣置换术可行性和安全性的初步研究. 中国循环杂志, 2022, 37(4): 341-347.
29. Faurie B, Abdellaoui M, Wautot F, et al. Rapid pacing using the left ventricular guidewire: reviving an old technique to simplify BAV and TAVI procedures. Catheter Cardiovasc Interv, 2016, 88(6): 988-993.
30. 刘新民, 宋光远, 滕思勇, 等. 使用左心室导丝起搏技术行经导管主动脉瓣置换术联合经皮冠状动脉介入治疗一站式手术一例. 中国循环杂志, 2020, 35(12): 1250-1252.
31. Hensey M, Sathananthan J, Alkhodair A, et al. Single-center prospective study examining use of the Wattson temporary pacing guidewire for transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2020, 96(4): 968-971.
32. Regueiro A, Alperi A, Vilalta V, et al. Safety and efficacy of TAVR with a pressure sensor and pacing guidewire: SAFE-TAVI trial. JACC Cardiovasc Interv, 2023, 16(24): 3016-3023.
33. Aurigemma C, Trani C, D'Errigo P, et al. Impact of vascular complications after transcatheter aortic valve implantation. VASC-OBSERVANT II sub-study. Catheter Cardiovasc Interv, 2023, 102(2): 381-391.
34. Vierhout BP, Pol RA, El Moumni M, et al. Editor’s choice - arteriotomy closure devices in EVAR, TEVAR, and TAVR: a systematic review and meta-analysis of randomised clinical trials and cohort studies. Eur J Vasc Endovasc Surg, 2017, 54(1): 104-115.
35. Fernandez-Lopez L, Chevalier B, Lefèvre T, et al. Implementation of the transradial approach as an alternative vascular access for transcatheter aortic valve replacement guidance: Experience froma high-volume center. Catheter Cardiovasc Interv, 2019, 93(7): 1367-1373.
36. Lauck SB, Kwon JY, Wood DA, et al. Avoidance of urinary catheterization to minimize in-hospital complications after transcatheter aortic valve implantation: an observational study. Eur J Cardiovasc Nurs, 2018, 17(1): 66-74.
37. Szerlip M, Tabachnick D, Hamandi M, et al. Safe implementation of enhanced recovery after surgery protocol in transfemoral transcatheter aortic valve replacement. Proc (Bayl Univ Med Cent), 2020, 34(1): 5-10.
38. Lauck SB, Yu M, Bancroft C, et al. Early mobilization after transcatheter aortic valve implantation: observational cohort study. Eur J Cardiovasc Nurs, 2024, 23(3): 296-304.
39. Lauck S, Sathananthan J, Achtem L, et al. Nurse-led post-procedure protocol to facilitate safe next-day discharge home: findings of the 3M tavr study. Can J Cardiol, 2019, 35(10): S204.
40. Worthington KP, Giannantonio E. Implementing a nurse-driven early ambulation protocol to enhance post-transcatheter aortic valve replacement outcomes: a quality improvement initiative. J Nurs Care Qual, 2025, 40(2): 187-192.
41. Hart L, Frankel R, Crooke G, et al. Promoting early mobility in patients after transcatheter aortic valve replacement: an evidence-based protocol. Crit Care Nurse, 2021, 41(5): e9-e16.
42. Cusin CN, Clark PA, Lauderbach CW Jr. , et al. Reducing length of stay for patients undergoing transcatheter aortic valve replacement using a prescreening approach. J Am Assoc Nurse Pract, 2022, 34(6): 844-849.
43. McCalmont G, Durand E, Lauck S, et al. Setting a benchmark for resource utilization and quality of care in patients undergoing transcatheter aortic valve implantation in Europe-Rationale and design of the international BENCHMARK registry. Clin Cardiol, 2021, 44(10): 1344-1353.
44. 毛越, 徐剑锋, 李梅, 等. 经导管主动脉瓣置换术患者Ⅰ期心脏康复的最佳证据应用. 中华护理杂志, 2022, 57(5): 563-569.
45. Murali S, Brugger N, Rincon F, et al. Cardiac ambulatory monitoring: new wireless device validated against conventional holter monitoring in a case series. Front Cardiovasc Med, 2020, 7: 587945.
46. Yenikomshian M, Jarvis J, Patton C, et al. Cardiac arrhythmia detection outcomes among patients monitored with the Zio patch system: a systematic literature review. Curr Med Res Opin, 2019, 35(10): 1659-1670.
47. Natarajan MK, Sheth TN, Wijeysundera HC, et al. Remote ECG monitoring to reduce complications following transcatheter aortic valve implantations: the redirect TAVI study. Europace, 2022, 24(9): 1475-1483.
48. 郑蓉蓉, 戴晗怡, 周道, 等. 智能手表在经导管主动脉瓣置换术后患者中应用三例. 中国循环杂志, 2023, 38(10): 1083-1086.

West China Medical Journal

Latest ArticlesResearch progress on early discharge of patients after transcatheter aortic valve replacement

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