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Updated: Jan 17, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Feasibility of same-day discharge after transcatheter aortic valve replacement: the North Shore Day Stay pathway
Karan Rao1,2,3, Princess Neila Litkouhi1,2, Alexandra Baer3
1Department of Cardiology, Royal North Shore Hospital, St. Leonards, Reserve Road, Sydney, 2065, Australia.
Insights
Same-day discharge after transcatheter aortic valve replacement (TAVR) is safe for selected low-risk patients in Australia. This approach is feasible with both self-expanding and balloon-expandable valves, supporting clinical pathway validation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Transcatheter aortic valve replacement (TAVR) is a key treatment for severe symptomatic aortic stenosis.
- Expanding TAVR indications increase demand on hospital resources.
- Previous studies on same-day discharge (SDD) after TAVR are limited, especially in Australian populations and for self-expanding valves.
Purpose of the Study:
- To assess the safety and feasibility of same-day discharge (SDD) after transfemoral TAVR in an Australian cohort.
- To evaluate the effectiveness of a locally derived clinical pathway ('The North Shore Pathway') in identifying suitable candidates for SDD.
- To compare in-hospital and 30-day outcomes between SDD patients and those discharged conventionally.
Main Methods:
- Prospective recruitment of patients undergoing transfemoral TAVR at two large-volume Australian centers (2021-2023).
- Retrospective application of 'The North Shore Pathway' to identify potential SDD candidates.
- Comparison of outcomes between the SDD cohort (n=20) and the standard discharge cohort (n=162).
Main Results:
- 11.0% of patients met SDD criteria, with no significant differences in baseline or procedural characteristics compared to the standard discharge cohort.
- The SDD cohort included both self-expanding (67.3%) and balloon-expandable valves (32.7%).
- No significant differences in hospital or 30-day adverse outcomes were observed between the SDD and standard discharge groups. Readmissions in the SDD group were infrequent and primarily non-cardiovascular.
Conclusions:
- Same-day discharge after TAVR is a feasible and safe strategy in a selected Australian patient population.
- The 'North Shore Pathway' shows promise as a tool for identifying low-risk TAVR patients suitable for SDD.
- Further prospective validation of clinical pathways is recommended to optimize SDD protocols for TAVR.
Abstract:
Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe symptomatic aortic stenosis but expanding indications have increased strain on hospital resources. Several studies assessed same-day discharge (SDD) after TAVR during the COVID-19 pandemic and showed it to be safe in well-selected, low-risk patients. However, more studies are warranted, with no studies in an Australian population and minimal data on self-expanding valves. Patients undergoing consecutive, transfemoral TAVR procedures at two large-volume centres in Sydney, Australia between 2021 and 2023 were prospectively recruited to the CONDUCT-TAVI study cohort. A locally derived clinical pathway ('The North Shore Pathway') was retrospectively applied to identify which patients would have been suitable for SDD. In-hospital and 30-day outcomes were compared between SDD patients and the remaining, ineligible patients (standard discharge cohort). Of 182 patients, 20 (11.0%) met SDD criteria. The total cohort received both self-expanding (67.3%) and balloon-expandable valves (32.7%). The SDD cohort had a higher proportion of females (55.0% vs. 21.5%, p = 0.04) but was otherwise comparable in baseline and procedural characteristics. No significant differences were found in hospital or 30-day outcomes. One SDD patient was readmitted with complete heart block requiring pacemaker implantation (day 20), and two patients had non-cardiovascular readmissions. No other adverse outcomes occurred in the SDD cohort. The present study suggests SDD after TAVR is feasible in both balloon-expandable and self-expanding cohorts. The study also supports prospective validation of the North Shore Day Stay pathway as a tool to safely identify low-risk patients that are suitable for SDD after TAVR.
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