Identifying patients suitable for same day discharge after Transcatheter Aortic Valve Implantation (NORTH SHORE DAY STAY TAVI)

This study aims to determine if the NORTH SHORE DAY STAY TAVI clinical pathway effectively identifies patients who are low-risk of post-procedural complications and suitable for same day discharge (SDD) after transfemoral Transcatheter Aortic Valve Implantation (TAVI). As part of the study, the clinical pathway will be applied to all patients undergoing transfemoral elective TAVI procedures at the included study sites. The NORTH SHORE DAY STAY TAVI clinical pathway involves comprehensive preprocedural, intraprocedural and postprocedural assessments to identify suitable patients and assess for early signs of complications. Postprocedural assessment will occur at 4-6 hours after TAVI. During that assessment the physician will assign the patient as either being suitable (NORTH SHORE DAY-STAY TAVI Score = 0) or unsuitable (NORTH SHORE DAY-STAY TAVI Score >= 1) for same day discharge based on objective screening criteria. Preprocedural requirements specified in the clinical pathway are non-urgent, elective TAVI, age greater than or equal to 18 years old, mobilising and living independently, adequate social supports to facilitate recovery at home and no significant medical comorbidities that necessitated additional in-hospital monitoring such as end stage renal disease or advanced dementia. Patients are additionally excluded if there was a right bundle branch block (RBBB) or atrioventricular block (AVB) on baseline ECG, unless the patient has a permanent pacemaker. Procedural requirements include no general anaesthesia (conscious sedation or local anaesthetic only), no high-grade AVB during valve deployment, no recorded intraprocedural complications and temporary pacing wires removed at the end of the case. Postprocedural requirements include: (1) no evidence of delirium, (2) no evidence of vascular access site complications such as haematoma or pseudoaneurysm, (3) no abnormal transthoracic echocardiogram features (LVEF > 30%, none or mild paravalvular leak, no new pericardial effusion and functioning implanted valve), (4) no new conduction abnormalities (new AVB including first degree block, or bundle branch block) unless the patient had a permanent pacemaker, (5) ability to mobilise 20 metres (assessed using the patient’s regular mobility aids) and (6) structural heart team review, together with patient and their family, to provide a final approval for SDD. A bedside duplex femoral ultrasound is the only additional assessment that is not part of standard care that will be required for included patients. Patients that undergo SDD will then be discharged with in-person review in a clinic the following day. Patients will again be followed up at 30 days after their TAVI to assess for outcome measures including all-cause mortality, rehospitalization and other complications. Follow up will involve a 15-30 minute in-person clinic review or telephone interview (if there are logistic and travel constraints such as regional or interstate patients) for patients. An additional review of medical records by the Research team will be performed to corroborate data collected and ensure comprehensive assessment for adverse events. Review by the patients regular treating Cardiologist and repeat transthoracic echocardiogram at 30 days after TAVI that is required by the study is part of standard care. Collection of this data will be performed by the Research Team. The following information will be collected for the study: - Patient demographics and clinical information (medical history and medication history) - Baseline clinical scores (quality of life measures, surgical risk score) - Baseline and post TAVI blood tests (haemoglobin, creatinine, albumin) - Pre and post TAVI echocardiograms (TTE) - Pre and post TAVI ECGs - CT (Computed Tomography) TAVI result (this is a pre-TAVI requirement, and is not an extra step of the research study) - TAVI procedure details (valve type and/or any complications) - Post-TAVI inpatient outcomes and clinical pathway score - Adverse events and complications that may have occurred, until 1 month after TAVI