Title: Inpatient TAVI During Acute Hospital Admission with Symptomatic Severe Aortic Stenosis
Abstract: Background: Most transcatheter aortic valve implantation (TAVI) procedures are performed electively with weeks to months of pre-procedural assessment and work-up process. Methods: In the 18 months between August 2016 and February 2018, twenty-two patients, admitted acutely with symptomatic severe aortic stenosis (AS), underwent TAVI during the same admission. The mean age of the patients was 80 (range: 53 – 89). Ten (45%) were female. All procedures were performed via the transfemoral access, and all but one (95%) under conscious sedation. All patients proceeded directly to TAVI with no balloon aortic valvuloplasty. Results: The mean length of time from admission to TAVI was 13 days (range: 2 – 22 days), and from TAVI to discharge it was 3 days (range: 1 – 17 days, median 2 days). The main factor contributing to the in-hospital waiting time was the availability of cardiac anaesthetic services. Seven patients (32%) were discharged the day after TAVI and six (27%) after two days. Complications occurred in two patients (9%), with one case of staphylococcus aureus bacteraemia and one patient with pre-existing paroxysmal atrial fibrillation who re-presented with a lacunar stroke on day 4 post-procedure, in the context of subtherapeutic INR and CHA2DS2-VASc score of 5. There was no mortality at the time of this submission. Conclusion: Inpatient TAVI for acutely admitted patients is safe and yields favourable outcomes. The majority of patients are discharged within 48 hours of the procedure. The largest proportion of the time spent in hospital remains the pre-procedural wait due to the restricted resources.