# Safety and feasibility of direct return to the ward after transcatheter aortic valve replacement: a prospective observational study

## TL;DR

This study shows that some patients can safely return directly to a regular hospital ward after heart valve replacement surgery, leading to shorter hospital stays.

## Contribution

The study introduces a new approach to postoperative care after TAVR by directly admitting eligible patients to the ward instead of the ICU.

## Key findings

- Direct ward transfer after TAVR had a 30-day safety event rate of 8.4%, comparable to the ICU group's 11.6%.
- Patients transferred to the ward had a significantly shorter hospital stay (4 vs. 6 days).
- Secondary outcomes like complications and mortality were similar between the two groups.

## Abstract

With increasing procedural volumes and improved safety, transcatheter aortic valve replacement (TAVR) programs are exploring strategies to streamline postoperative care. This study aimed to evaluate the safety and feasibility of direct return to the cardiovascular surgery ward after TAVR.

This prospective observational study enrolled patients who underwent TAVR between January and April 2024 and were directly admitted to the cardiovascular surgery ward postoperatively if they met predefined criteria. A historical cohort of patients treated between January and December 2023 who met the same eligibility criteria but were admitted to the CICU served as the control group. Propensity score matching was used to ensure comparability between groups. The primary outcome was the composite early safety endpoint defined by Valve Academic Research Consortium-3 (VARC-3). Secondary outcomes included 30-day major complications (per VARC-3), mortality, readmission, postoperative delirium, unplanned ICU transfer, and postoperative length of stay.

Of the 168 patients who underwent TAVR between January and April 2024, 130 (77.4%) were directly transferred to the ward. In the historical cohort, 231 patients were included as controls. After propensity score matching, 95 patients were included in each group. The 30-day composite early safety event rate was 8.4% in the ward group and 11.6% in the CICU group (OR = 0.7, 95%CI: 0.3–1.7), with no significant difference. Secondary outcomes, including major complications, mortality, readmissions, postoperative delirium, and unplanned ICU transfers, were comparable between groups. Median postoperative length of stay was significantly shorter in the ward group (4 vs. 6 days; mean difference 1.9 days, 95%CI: 1.3–2.5).

Direct ward transfer after TAVR appears safe and feasible in selected patients and is associated with a shorter hospital stays compared to routine CICU admission.