Transcatheter aortic valve replacement performed with selective telemetry monitoring: A prospective study. (1st May 2021)

• Record Type: Journal Article
• Authors: Akodad, Mariama; Aldhaheri, Eissa; Marin, Gregory; Roubille, François; Macia, Jean-Christophe; Gandet, Thomas; Delseny, Delphine; Schmutz, Laurent; Lattuca, Benoit; Robert, Pierre; Dubard, Arnaud; Robert, Gabriel; Targosz, Frederic; Maupas, Eric; Albat, Bernard; Cayla, Guillaume; Leclercq, Florence
• Is Part Of: International journal of cardiology. Volume 330(2021)
• Page Start: 158
• Page End: 163
• Publication Date: 2021-05-01
• Subjects: TAVR -- Complications -- Intensive care unit -- Conductive disorders -- Telemetry monitoring; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.02.028
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Telemetry monitoring (TM) with or without intensive care unit (ICU) admission is the standard of care after Transcatheter aortic valve replacement (TAVR). Regarding to improvements of the technique and procedural results, TM may be considered only in selected patients. We aimed to confirm feasibility and safety of selective TM in patients undergoing TAVR. Methods: We prospectively evaluated 449 consecutive patients undergoing TAVR. Patients were transferred to general cardiology ward (GCW) without TM after the procedure when stable clinical state, transfemoral access, no baseline right bundle branch block (RBBB), left ventricular ejection fraction (LVEF) > 40%, and no complication including any electrocardiogram (ECG) change within 1 h after the procedure ("low-risk" group). Others patients were considered for TM in ICU ("high-risk" group). The primary endpoint evaluated in-hospital major adverse events after unit admission according to VARC-2 criteria. Results: The mean age was 81.8 ± 7.5 years and mean EuroSCORE II was 7.5 ± 4.8%. In total, 116 patients (25.8%) were considered as "low-risk" patients and 163 patients (36.3%) were referred to GCW, including those with immediate pacemaker implantation. A total of 96 patients (21.3%) reached the primary endpoint including mainly conductive disorders (12.8%). No major adverse events, particularly no late severe conductive disorder, occurred in the "low-risk" group (negative predictive value of 100%). Baseline RBBB ( p < 0.01), LVEF < 40% ( p = 0.02) and "high-risk" group ( p < 0.01) were predictive of outcomes. Conclusions: Using rigorous periprocedural selection criteria, patients' admission in GCW without TM can be routinely and safely performed in 1/3 of patients after TAVR. Highlights: TAVR is feasible and safe without telemetry monotoring in one third of patients. Rigorous predefined medical and ECG criteria and 1-h post procedure monitoring without adverse events and without any ECG changes allow this strategy.