Direct Admission of Selected Patients to Intermediate Cardiology Unit After TAVI is Feasible and Safe

Anat Berkovitz Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Ilan Goldenberg Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Yael Peled Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Michael Berger Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Amit Segev Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Paul Fefer Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Elad Maor Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Yoni Grossman Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Michael Kogan Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Arsalan Abumuch Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Younis Arwa Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Sagit Ben Zekry Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Victor Guetta Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel Israel Barbash Leviev Heart Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel

Background: Transcatheter aortic valve implantation (TAVI) volumes increase rapidly as the procedure is performed in lower risk patients. Common practice is to observe TAVI patients at least for 24 hours in intensive care unit (ICU) to monitor for possible post procedural complications. This practice poses increasing burden on ICU staff and bed availability.

Aim: To assess safety of admitting post-TAVI patients directly to intermediate cardiology unit (INTER) following the procedure.

Methods: Between May – December 2016 qualifying patients undergoing transfemoral TAVI were admitted directly to INTER after 2-hour observation in cath lab recovery room. Criteria to qualify for direct INTER were: normal QRS complex on baseline ECG, no new conduction abnormality immediately following TAVI, hemodynamic stable patient, no valve related or neurologic complication. Baseline, procedural, in hospital and long term outcome were recorded.

Results: Eight of 110 patients (7.3%) were admitted directly to INTER. INTER patients were of the same age (average 82 years) and gender (50% males) as ICU patients with lower EuroSCORE II (2.4 vs. 3.8%, p=0.3). Half of INTER patients had pre-procedural permanent pacemaker, compared to 6% in the ICU group (p=0.002). Balloon expandable valve was implanted in 50% of the INTER patients compared to 32% in the ICU group (p=0.4). Acute kidney injury occured in 0% vs. 18% (p=0.3), in hospital stroke in 0% vs 0.9% (p=1), new atrial fibrillation episode 0% vs. 11% (p=1), and new permanent pacemaker implantation 0% vs. 16% (p=1). Hospitalization duration was non-significantly shorter for INTER patients (3±2.8 vs. 6.4±5.9 days, p=0.1). In hospital mortality was 0% for both groups, 1-year mortality was 0% vs. 12% (p=0.6).

Conclusions: Initial experience with structured criteria to identify low risk patients is effective for selecting patients for direct admission to an intermediate cardiology unit immediately after TAVI.

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