Background Despite the availability of guidelines for the performance of transcatheter aortic valve implantation (TAVI), current treatment pathways vary between countries and institutions, which impact on the mean duration of postprocedure hospitalization. Methods and Results This was a prospective, multicenter registry of 502 patients to validate the appropriateness of discharge timing after transfemoral TAVI, using prespecified risk criteria from FAST-TAVI (Feasibility and Safety of Early Discharge After Transfemoral [TF] Transcatheter Aortic Valve Implantation), based on hospital events within 1-year after discharge. The end point-a composite of all-cause mortality, vascular access-related complications, permanent pacemaker implantation, stroke, cardiac rehospitalization, kidney failure, and major bleeding-was reached in 27.0% of patients (95% CI, 23.3-31.2) within 1 year after intervention; 7.5% (95% CI, 5.5-10.2) had in-hospital complications before discharge and 19.6% (95% CI, 16.3-23.4) within 1 year after discharge. Overall mortality within 1 year after discharge was 7.3% and rates of cardiac rehospitalization 13.5%, permanent pacemaker implantation 4.2%, any stroke 1.8%, vascular-access-related complications 0.7%, life-threatening bleeding 0.7%, and kidney failure 0.4%. Composite events within 1 year after discharge were observed in 18.8% and 24.3% of patients with low risk of complications/early (≤3 days) discharge and high risk and discharged late (>3 days) (concordant discharge), respectively. Event rate in patients with discordant discharge was 14.3% with low risk but discharged late and increased to 50.0% in patients with high risk but discharged in ≤3 days. Conclusions The FAST-TAVI risk assessment provides a tool for appropriate, risk-based discharge that was validated with the 1-year event rate after transfemoral TAVI. Registration URL: https://www.ClinicalTrials.gov; Unique identifier: NCT02404467.

Cardiac Surgery Department Clinica San Gaudenzio Novara Italy

Cardiology Department Department of Advanced Biomedical Sciences University of Naples Italy

Cardiology Department Leiden University Medical Center Leiden The Netherlands

Cardiology Department Montevergine Clinic Mercogliano Italy

Cardiology Department Papworth Hospital Cambridge United Kingdom

Cardiology Department Royal Victoria Hospital Belfast United Kingdom

Cardiology Department University of Bari Aldo Moro Bari Italy

Cardiothoracic Division The James Cook University Hospital Middlesbrough United Kingdom

Cardiovascular and Thoracic Department S Orsola Malpighi University Hospital Bologna Italy

Catania Division of Cardiology Policlinico Vittorio Emanuele HospitalUniversity of Catania Italy

Department of Cardiology Amsterdam UMCUniversity of Amsterdam The Netherlands

Edwards Lifesciences Nyon Switzerland

Edwards Lifesciences Prague Czech Republic

Institute for Pharmacology and Preventive Medicine Cloppenburg Germany

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The implementation of a streamlined TAVI patient pathway across five European countries: BENCHMARK registry

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

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ClinicalTrials.gov
NCT02404467