Postinterventional surveillance at a dedicated valve unit is safe and reduces intensive care utilization after TAVR

The postprocedural care pathway after transcatheter aortic valve replacement (TAVR) mostly includes monitoring patients for 24-48 h at an intensive care unit (ICU) or intermediate care unit (routine intensive care monitoring = ICM). To reduce the need for postprocedural intensive care surveillance, our center established a dedicated monitoring unit (valve unit = VU) for pre- and postprocedural care of TAVR patients.

The aim of this prospective case-control study was to evaluate outcomes of patients directly before and after the introduction of the VU. Starting in April 2020 TAVR patients were directly transferred to a VU after the procedure with 24-h telemetric electrocardiogram (ECG) and non-invasive blood pressure monitoring, which was spatially integrated into a general cardiology ward. Patients with hemodynamic or respiratory instability, stroke, delirium, and severe bleeding complications were still directly transferred to the ICU.

796 consecutive patients treated with TAVR at our center were included. 592 patients had been treated during ICM and 204 after the establishment of the VU. The overall rate of events was similar before and after the implementation of the valve unit. 182 of 592 ICM patients developed study-specific endpoints (30.7%) compared to 60 of 204 VU patients (29.4%) (P value for difference: 0.87). VU patients showed a trend towards a lower rate of delirium (ICM 3.5% vs VU 1%, p-value 0.06).

Introduction of a VU for patient monitoring after TAVR with prespecified criteria for postinterventional ICU surveillance reduced the percentage of postinterventional ICU admissions by 73% without increasing the overall rate of adverse events.