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thesis manuscript (Ahmad Alkhalil).pdf (773.3 KB)

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Outcomes Of Early Versus Late Discharge In Transfemoral Transcatheter Aortic Valve Replacement Via Minimally Invasive Strategy: A Propensity-Matched Analysis

Alkhalil, Ahmad
http://orcid.org/0000-0002-2076-3377
http://rave.ohiolink.edu/etdc/view?acc_num=case1465592493

Abstract Details

2016, Master of Sciences, Case Western Reserve University, Statistics.
Objectives: To determine the feasibility and safety of early discharge strategy following transfemoral transcatheter aortic valve replacement (TAVR) via minimally invasive strategy (MIS). Methods: Two hundred sixty-eight patients who underwent transfemoral TAVR via MIS between 3/2011 and 12/2015 were included. Early discharge was defined as post-procedural length of stay = 3 days. There were 163 patients in the early discharge group and 105 patients in the late discharge group. Propensity score matching yielded 54 pairs of matched patients between the two groups. Thirty-day mortality, thirty-day rehospitalization and long-term survival data were analyzed. Multivariate analysis was used to define predictors of early discharge. Results: Using propensity matched analysis, 30-day mortality was 0% in early discharge vs. 5.5% in late discharge, p=0.08. Thirty-day rehospitalization was 3.7% in early discharge vs. 13 % in late discharge, p=0.16 (OR of 30-day rehospitalization in early discharge was 0.17[95% CI: 0.02-1.38]). Mortality hazard ratio in early discharge was 0.43 [95% CI: 0.11, 1.66]. Survival analysis of the matched sample showed no statistical difference between the groups with Log-rank test p= 0.2. Concerning predictors of early discharge, minor vascular complication, any bleeding, blood transfusion and new pacemaker had lower odds ratios for early discharge. In contrast, discharge to home had a higher odds ratio for early discharge. Conclusion: Early discharge strategy in patients undergoing transfemoral TAVR via MIS is feasible without imposing higher 30-day mortality or rehospitalization. Such a strategy may minimize the functional decline due to longer hospitalization and could lead to lower TAVR costs.
James Spilsbury, Ph.D (Committee Chair)
38 p.
Medicine
TAVR; aortic stenosis; transcatheter aortic valve replacement; early discharge

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Citations

  • Alkhalil, A. (2016). Outcomes Of Early Versus Late Discharge In Transfemoral Transcatheter Aortic Valve Replacement Via Minimally Invasive Strategy: A Propensity-Matched Analysis [Master's thesis, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1465592493

    APA Style (7th edition)

  • Alkhalil, Ahmad. Outcomes Of Early Versus Late Discharge In Transfemoral Transcatheter Aortic Valve Replacement Via Minimally Invasive Strategy: A Propensity-Matched Analysis. 2016. Case Western Reserve University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1465592493.

    MLA Style (8th edition)

  • Alkhalil, Ahmad. "Outcomes Of Early Versus Late Discharge In Transfemoral Transcatheter Aortic Valve Replacement Via Minimally Invasive Strategy: A Propensity-Matched Analysis." Master's thesis, Case Western Reserve University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=case1465592493

    Chicago Manual of Style (17th edition)

case1465592493
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© 2016, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.