Reducing length of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial
Authors: Durand Eric , Beziau-Gasnier Delphine , Michel Morgane , Iung Bernard , Tchetche Didier , Bonnet Guillaume , Lhermusier Thibault , Gilard Martine , Souteyrand Geraud , Bouleti Claire , Ohlmann Patrick , Lefevre Thierry , Beygui Farzin , Chassaing Stephan , Chevreul Karine , Eltchaninoff Hélène ,   FAST-TAVI II, Alos Benjamin , Arnould Marc-Antoine , Bar Olivier , Barbey Christophe , Bertrand Bernard , Beygui Farzin , Bignon Mathieu , Bouchat Marine , Bouisset Frédéric , Bouleti Claire , Campelo-Parada Fransisco , Chassaing Stephan , Combaret Nicolas , Darodes Nicole , Delepine Stéphane , Didier Romain , Dongay Bruno , Dumonteil Nicolas , Fouassier David , Gallet de Saint Aurin Romain , Gilard Martine , Gouffran Guillaume , Himbert Dominique , Le Bivic Louis , Lefèvre Thierry , Lemaitre Adrien , Leroux Lionel , Levy Gilles , Lhermusier Thibaut , Lorgis Luc , Morelle Jean-François , Ohlmann Patrick , Piot Christophe , Pommier Thibaut , Rebouh Idir , Roule Vincent , Rusinaru Dan , Souteyrand Géraud , Spaulding Christian , Tchetche Didier , Teiger Emmanuel , Tribouilloy Christophe ,   STOP-AS investigators, Eltchaninoff Hélène , Bellien Jérémy , Bertrand Benjamin , Beygui Farzin , Béziau-Gasnier Delphine , Brakenhielm Ebba , Caligiuri Giuseppina , Chevreul Karine , Debroucker Frédérique , Durand Eric , Fraschini Christophe , Gilard Martine , Iung Bernard , Kamel Said , Laschet Jamila , Manrique Alain , Messas Emmanuel , Messika-Zeitoun David , Pinet Florence , Richard Vincent , Saloux Eric , Thoenes Martin , Tribouilloy Christophe , Vézier Claire 
Published: March 2024

Abstract

Background and Aims
The length of stay (LOS) after transcatheter aortic valve implantation (TAVI) remains extremely variable whereas early discharge has been shown to be feasible and safe. The study objective was to evaluate the efficacy and safety of an intervention aimed at reducing LOS after transfemoral TAVI.

Methods
FAST-TAVI II is a prospective, multicentre, cluster, randomized, controlled study including patients with severe symptomatic aortic stenosis, who had transfemoral TAVI. The intervention consisted in a dedicated training programme to implement 10 quality of care measures to reduce LOS with an implementation phase of eight weeks. The primary endpoint was the proportion of patients discharged early within 3 days. Secondary endpoints included: LOS, 30-day mortality and 30-day incidence of readmission for cardiovascular events.

Results
During the study period, 969 patients were enrolled in the intervention group and 860 patients in the control group. Mean age was 81.9 ± 6.6 years and mean EuroSCORE II was 4.4 ± 4.5%. Early discharge was achieved in 563 (58.1%) patients in the intervention group vs. 364 (42.3%) patients in the control group (P &lt; .0001). Median LOS was significantly reduced in the intervention group compared to the control group [3 (IQR: 3) vs. 4 days (IQR: 3), P &lt; .0001]. Thirty-day mortality was low and similar in the two groups (0.5% vs. 0.9%, P = .30), as were 30-day readmissions (4.6% vs. 2.8%, P = .28).

Conclusions
The intervention was simple and fast to implement, and was effective and safe to reduce LOS and increase the proportion of patients discharged early after TAVI (NCT04503655).