Comparison of a Pure Plug-Based Versus a Primary Suture-Based Vascular Closure Device Strategy for Transfemoral Transcatheter Aortic Valve Replacement: The CHOICE-CLOSURE Randomized Clinical Trial

Abdel-Wahab, Mohamed et al. https://doi.org/10.1161/CIRCULATIONAHA.121.057856 Circ. 5 Nov 2021

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Utilizing Adjunctive Technologies For Same-Day Discharge Post TAVR

Philippe Généreux, MD – Morristown Medical Center

Background

  • Patients undergoing TAVR procedures may be candidates for early or same-day discharge if certain criteria are met including no intraprocedural bleeding complications1.
  • COVID-19 has resulted in a surge of ICU admissions that has stressed ICU resources within hospital systems, limiting bed capacity.
  • Providers seek objective metrics to confirm safety of patient disposition for early discharge.
  • The Early Bird® Bleed Monitoring System provides assurance to clinicians that no intra and post- procedural bleeding events occur for a patient vulnerable to bleeding complications.
  • The Zio® (iRhythm® Technologies, Inc.) is a wearable heart monitor that attaches to the patient’s chest for a period of up to 14 days.

Case

  • 69-year-old male
  • TAVR procedure incorporating the Zio patch and the Early Bird
  • Patient is a candidate for same-day discharge given that there is no detection of bleeding by the Early Bird

Results

  • Following successful TAVR procedure, the Early Bird remained activated for post-procedure monitoring.
  • With no identified procedural complications and no bleed notifications from the Early Bird, the patient was safely discharged on the same day.
  • The Zio patch remained on the patient for 2 weeks to monitor conduction disturbances.
  • The patient was out on the golf course 2 days following the procedure.

Discussion Points

Integration of adjunctive technologies, such as the Early Bird and Zio, may make early or same-day discharge following a TAVR procedure feasible.

Incorporation of a risk-stratified same-day discharge TAVR algorithm has the potential to ease patient disposition and satisfaction, while reducing hospital resource utilization and ICU burden.

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1 Généreux P et al. Catheterization and Cardiovascular Interventions 87:980-982, 2016.

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