0177: Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation

There is currently no consensus on the duration of monitoring required after TAVI. Between october 2009 and november 2013, 371 consecutive patients underwent transfemoral TAVI in our institution, all performed using the Edwards SAPIEN-XT prosthesis and local anesthesia.All the patients were monitored in intensive care unit for at least 24 hours after TAVI. We excluded 12 Patients implanted with a Corevalve, 14 patients who died before discharge, and 8 patients who were not discharge d straight home.The remaining 337 patients were discharged at home, 121 (36%) within 3 days (early discharge group) and 216 (64%) more than 3 days after TAVI (conventional discharge group).The primary end point combined death and re-hospitalization at 30 days. All adverse events were adjudicated according to the Valve Academic Research Consortium-2.The incidence of early discharge rose from 0% in 2009 to 53.2% of cases in 2013. Before (plutôt prior to?) TAVI, patients in the early discharge group were less symptomatic (NYHA >III: 64.5% vs. 75.5%, p=0.01) and had less renal failure (creatinine: 102.1±41.0 vs. 113.3±58.9µmol/l, p=0.04), less atrial fibrillation (33.1% vs. 46.3%, p=0.02), and less previous balloon aortic valvuloplasty (11.6% vs. 23.1%, p=0.01) than those in the conventional discharge group. In contrast, patients in the early discharge group were more likely to have a pacemaker before TAVI (16.5% vs. 8.3%, p=0.02).After multivariable analysis, pacemaker before TAVI (OR 0.44; 95% CI 0.19-0.99; p=0.05), previous balloon aortic valvuloplasty (OR 2.26; 95% CI 1.10-4.64; p=0.03), transfusions (OR 9.6; 95% CI 2.36-38.94; p=0.002), and delta creatinin (OR 0.99; 95% CI 0.98-0.99; p=0.02) were independent predictive factors of early discharge. The primary end-point occurred in 7 (5.8%) patients in the early discharge group and in 16 (7.1%) patients in the conventional discharge group without significant difference (p=0.60). No patients died in the early discharge group at 30-day follow-up.The results of our study suggest that early discharge is feasible and safe after TAVI using the Edwards-SAPIEN XT prosthesis in selected patient