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Early discharge after TAVI: should we still be afraid of conduction disturbances?
Session:
Painel 11 - Cardiologia Intervenção 3
Speaker:
Mariana Ribeiro Silva
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters
FP Number:
---
Authors:
Mariana Ribeiro Da Silva; Alberto Rodrigues; Cláudio Guerreiro; Ana Mosalina; Gualter Santos Silva; Pedro Gonçalves Teixeira; Pedro Ribeiro Queirós; Mariana S. Brandão; Diogo Ferreira; Daniel Caeiro; Adelaide V. Dias; Olga Sousa; Marco André Oliveira; João Primo; Pedro Braga
Abstract
<p><strong>Introduction:</strong> Conduction disturbances (CD) after TAVI remains the most frequent complication of the procedure, frequently increasing the length of hospital stay. A lack of consensus exists regarding in-hospital management of CD post-TAVI.</p> <p><strong>Objectives:</strong> To evaluate if an early discharge (ED) protocol could be safely implemented in patients (pts) with CD post-TAVI.</p> <p><strong>Methods</strong>: Retrospective study of all pts submitted to TAVI between 2016 and 2018. Pts with prior permanent pacemaker (PP) and non-transfemoral approach were excluded. ECG data before, immediately after the procedure and at day 3 post-TAVI were collected, and continuous telemetry monitoring was recorded. We applied a recently proposed ED algorithm <strong>(Table 1)</strong> to identify which pts could have been candidates for ED. ED was defined as discharge in the first 72 hours (h) after the procedure. We evaluated if an ED strategy would have been safe at 1-year follow-up (FUP), as defined by the absence of need for PP, syncope and mortality.</p> <p><strong>Results and discussion:</strong> 242 pts were included, 44,8% males, mean age 80,4 years, mean Euroscore II 5,4 and the majority implanted a self-expandable prosthesis (64,1%). Mean hospital stay after TAVI was 7,7 days. The most frequent CD after TAVI were: new onset left bundle brunch block (36%) and high degree atrioventricular block (HAVB) (16,3%). During hospital stay 21,6% needed PP, mainly because of HAVB (mainly implanted in the first 72h).</p> <p>According to the proposed algorithm, 70,7% of our pts were ED-candidates. ED-candidates had lower prevalence of predilation (18,5% vs 36,8%, p=0,008) with no significant differences between type of prosthesis or baseline ECG. ED-candidates had smaller PR interval post-TAVI (184,5 vs 202,5 ms, p=0,044) and smaller PR and QRS at 72h (p<0,001 in both).</p> <p>At 1-year FUP, only 2,3% of ED-candidates needed a PP (vs 37,7% non-ED, p<0,001). It is noteworthy that in those ED-candidates who needed a PP during FUP, the percentage of ventricular pacing was less than 2% at 6 months. In the FUP period, 3,2% of ED-candidates presented at the ER because of syncope, with no significant differences to non-ED pts. No differences between groups were found in 30-days and 1-year ER presentation because of syncope or all-cause mortality.</p> <p><strong>Conclusion:</strong> According to the proposed algorithm for ED in pts with CD post-TAVI, pts with specific ECG characteristics and without rhythm events during continuous telemetry monitoring can be early discharged with long-term safety.</p>
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