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Published on: August 8, 2025
Same-Day Discharge Post-Transcatheter Aortic Valve Replacement During the COVID-19 Pandemic: The Multicenter PROTECT
Madeleine Barker1, Janarthanan Sathananthan1, Emily Perdoncin2
1Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Same-day discharge after transcatheter aortic valve replacement (TAVR) is safe for selected low-risk patients. This approach can help manage healthcare resources while providing essential cardiovascular care.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Healthcare Management
Background:
- The COVID-19 pandemic strained global healthcare systems.
- Same-day discharge (SDD) for select transcatheter aortic valve replacement (TAVR) patients can optimize resource allocation.
- This strategy supports essential cardiovascular care delivery amidst pandemic-related challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of same-day discharge (SDD) following transcatheter aortic valve replacement (TAVR).
- To assess the feasibility of SDD in selected TAVR patients during the COVID-19 pandemic.
- To determine the clinical outcomes associated with SDD in TAVR patients.
Main Methods:
- A prospective study involving 124 highly selected patients undergoing elective transfemoral TAVR across 7 international sites.
- Patient selection for SDD was determined by local multidisciplinary heart teams.
- The primary outcome was a composite of major adverse events within 30 days, including cardiovascular death, stroke, myocardial infarction, readmission, major vascular complications, and new permanent pacemaker implantation.
Main Results:
- No major vascular complications, strokes, or deaths occurred during the index admission among the 124 SDD patients.
- One patient (0.8%) required a permanent pacemaker (PPM) for heart block and was discharged the same day.
- The 30-day composite adverse event rate was 5.7% (6 out of 106 patients), with no PPM requirement between discharge and follow-up.
Conclusions:
- Same-day discharge (SDD) is a safe and feasible strategy for carefully selected, low-risk TAVR patients.
- This approach can be valuable for maintaining essential cardiovascular services.
- SDD may play a role in selected TAVR patients even after the COVID-19 pandemic subsides.
Objectives:
The aim of this study was to determine the safety and efficacy of same-day discharge (SDD) after transcatheter aortic valve replacement (TAVR) during the COVID-19 pandemic.
Background:
The COVID-19 pandemic has placed significant stress on health care systems worldwide. SDD in highly selected TAVR patients can facilitate the provision of essential cardiovascular care while managing competing COVID-19 resource demands.
Methods:
Patient selection for SDD was at the discretion of the local multidisciplinary heart team, across 7 international sites. The primary outcome was a composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new permanent pacemaker (PPM) implantation.
Results:
From March 2020 to August 2021, 124 of 2,100 patients who underwent elective transfemoral TAVR were selected for SDD. The average age was 78.9 ± 7.8 years, the median Society of Thoracic Surgeons score was 2.4 (IQR: 1.4-4.2), and 32.3% (n = 40) had preexisting PPMs. There were no major vascular complications, strokes, or deaths during the index admission. One patient (0.8%) required PPM implantation for complete heart block and was discharged the same day. No patient required a PPM between discharge home and 30-day follow-up. The composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new PPM at 30 days occurred in 5.7% patients (n = 6 of 106).
Conclusions:
SDD post-TAVR is safe and feasible in selected patients at low risk for adverse clinical events postdischarge. This strategy may have a potential role in highly selected patients even when the COVID-19 pandemic abates.
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