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Predictors for non-delayed discharge after transcatheter aortic valve replacement: utility of echocardiographic parameters

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Abstract

Considering that transcatheter aortic valve replacement (TAVR) procedures have become less invasive, the duration for monitoring patient care after a successful TAVR can be reduced. Therefore, this study aimed to investigate the prognostic value of baseline echocardiographic parameters for non-delayed discharge in patients after TAVR. The study group included 154 consecutive patients (mean age: 84.4 ± 4.5 years; and 101 women) who underwent a TAVR. Comprehensive echocardiograms including both side indices of myocardial performance (IMP) and blood tests were obtained prior to the TAVR procedure. The median post-TAVR length of stay was 6 days while the mode and first quartile were both 4 days. Receiver operating characteristic curve analysis showed that the optimum cut-off value of the left-sided IMP in patients with a normal left ventricular ejection fraction (LVEF, ≥ 50%) (n = 124) for non-delayed discharge (≤ 4 days) was 0.34 with an area under the curve (AUC) value of 0.71563 and p value of < 0.0001, while the optimum cut-off value in patients with reduced LVEF (< 50%) (n = 30) was 0.47 with an AUC value of 0.77778 and p value of < 0.0120. An adjusted analysis indicated the negative left-sided IMP results as the only predictor for non-delayed discharge (p < 0.0001). Furthermore, the adjusted predictors for survival without early cardiovascular re-hospitalization within 6 months after TAVR were the positive left-sided IMP result, when the cut-off value of 0.52 was used, and the presence of elevated RAP of 8 to 15 mmHg. The early discharge policy should be carefully considered in high-risk populations, but the left-sided IMP may play a significant role in the pre-screening process.

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Acknowledgements

We thank the medical ultrasound imaging laboratory of Tokai University School of Medicine Hospital for their valuable contributions in echocardiographic imaging.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan

    Tomoo Nagai, Hitomi Horinouchi, Yohei Ohno, Tsutomu Murakami, Katsuaki Sakai, Gaku Nakazawa, Koichiro Yoshioka & Yuji Ikari

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  1. Tomoo Nagai
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  2. Hitomi Horinouchi
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Correspondence to Tomoo Nagai.

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Nagai, T., Horinouchi, H., Ohno, Y. et al. Predictors for non-delayed discharge after transcatheter aortic valve replacement: utility of echocardiographic parameters. Int J Cardiovasc Imaging 37, 47–58 (2021). https://doi.org/10.1007/s10554-020-01944-z

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