Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 149 No. 2526 (2019)

Determinants of hospital length of stay after transcatheter aortic valve implantation with self-expanding prostheses: a prospective, single centre observational study

  • Angela Frei
  • Dionysios Adamopoulos
  • Hajo Müller
  • Bernhard Walder
  • Nils Perrin
  • Thomas Reynaud
  • Sylvain Ho
  • Marco Roffi
  • François Mach
  • Marc-Joseph Licker
  • Stéphane Noble
Cite this as:
Swiss Med Wkly. 2019;149:w20095



We sought to identify baseline and periprocedural variables affecting hospital length of stay (LoS) in patients undergoing transcatheter aortic valve implantation (TAVI).


Data on 304 consecutive patients undergoing TAVI at a single centre between August 2008 and December 2017 were collected prospectively. All patients underwent a complete clinical, echocardiographic and laboratory evaluation including a comprehensive frailty assessment at baseline. LoS was defined as the number of in-hospital days after the TAVI procedure during the index hospitalisation until the time the patient left the hospital for home or a rehabilitation clinic.


The mean LoS was 10.4 ± 7.1 days (median 8, interquartile range 5–12) with a significant trend towards shorter LoS over time (p <0.001). Patients discharged directly home were more likely to have shorter LoS (p = 0.007). All periprocedural complications were significantly associated with prolonged LoS (p <0.05 for all). Multivariate analysis showed an independent association between LoS and emergency admission (beta 3.24 ± 1.56, p = 0.039), baseline gait speed (beta: 0.39 ± 0.16, p = 0.018), baseline serum C-reactive protein (CRP, beta 0.14 ± 0.04, p = 0.001) and subclavian access (beta 8.27 ± 2 .9, p = 0.005). Gait speed and serum CRP remained significant determinants of LoS even after adjustment for periprocedural complications and patients’ discharge destination.


Baseline gait speed and serum CRP are significant independent determinants of LoS after TAVI.


  1. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al.; ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–91. doi:.
  2. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, 3rd, Fleisher LA, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(25):e1159–95. doi:.
  3. Durand E, Borz B, Godin M, Tron C, Litzler PY, Bessou JP, et al. Transfemoral aortic valve replacement with the Edwards SAPIEN and Edwards SAPIEN XT prosthesis using exclusively local anesthesia and fluoroscopic guidance: feasibility and 30-day outcomes. JACC Cardiovasc Interv. 2012;5(5):461–7. doi:.
  4. Greif M, Lange P, Näbauer M, Schwarz F, Becker C, Schmitz C, et al. Transcutaneous aortic valve replacement with the Edwards SAPIEN XT and Medtronic CoreValve prosthesis under fluoroscopic guidance and local anaesthesia only. Heart. 2014;100(9):691–5. doi:.
  5. Durand E, Eltchaninoff H, Canville A, Bouhzam N, Godin M, Tron C, et al. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis. Am J Cardiol. 2015;115(8):1116–22. doi:.
  6. Barbanti M, Capranzano P, Ohno Y, Attizzani GF, Gulino S, Immè S, et al. Early discharge after transfemoral transcatheter aortic valve implantation. Heart. 2015;101(18):1485–90. doi:.
  7. Mallikethi-Reddy S, Akintoye E, Telila T, Sudhakar R, Jagadeesh K, Briasoulis A, et al. Transcatheter aortic valve implantation in the United States: Predictors of early hospital discharge. J Interv Cardiol. 2017;30(2):149–55. doi:.
  8. Reynolds MR, Lei Y, Wang K, Chinnakondepalli K, Vilain KA, Magnuson EA, et al.; CoreValve US High Risk Pivotal Trial Investigators. Cost-Effectiveness of Transcatheter Aortic Valve Replacement With a Self-Expanding Prosthesis Versus Surgical Aortic Valve Replacement. J Am Coll Cardiol. 2016;67(1):29–38. doi:.
  9. Stortecky S, Franzone A, Heg D, Tueller D, Noble S, Pilgrim T, et al. Temporal Trends in Adoption and Outcomes of Transcatheter Aortic Valve Implantation: A Swisstavi Registry Analysis. Eur Heart J Qual Care Clin Outcomes. 2018:qcy048. doi:.
  10. Afilalo J, Eisenberg MJ, Morin JF, Bergman H, Monette J, Noiseux N, et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010;56(20):1668–76. doi:.
  11. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69–74.
  12. Perrin N, Roffi M, Frei A, Hachulla AL, Ellenberger C, Müller H, et al. Thirty-day Outcome Following CoreValve Evolut R Transcatheter Aortic Valve Implantation: An All-comers Prospective Study. Rev Esp Cardiol (Engl Ed). 2017;70(9):713–9. doi:.
  13. Perrin N, Ellenberger C, Licker M, Hachulla AL, Cikirikcioglu M, Frei A, et al. Management of vascular complications following transcatheter aortic valve implantation. Arch Cardiovasc Dis. 2015;108(10):491–501. doi:.
  14. Noble S, Roffi M, Burri H. Use of an explanted pacemaker connected to a regular screw-in lead for temporary pacing. Rev Esp Cardiol (Engl Ed). 2011;64(12):1229–30. doi:.
  15. Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J. 2012;33(19):2403–18. doi:.
  16. Kleczynski P, Dziewierz A, Bagienski M, Rzeszutko L, Sorysz D, Trebacz J, et al. Impact of frailty on mortality after transcatheter aortic valve implantation. Am Heart J. 2017;185:52–8. doi:.
  17. Green P, Woglom AE, Genereux P, Daneault B, Paradis JM, Schnell S, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC Cardiovasc Interv. 2012;5(9):974–81. doi:.
  18. Afilalo J, Lauck S, Kim DH, Lefèvre T, Piazza N, Lachapelle K, et al. Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study. J Am Coll Cardiol. 2017;70(6):689–700. doi:.
  19. Perry TE, Muehlschlegel JD, Liu KY, Fox AA, Collard CD, Body SC, et al.; CABG Genomics Investigators. Preoperative C-reactive protein predicts long-term mortality and hospital length of stay after primary, nonemergent coronary artery bypass grafting. Anesthesiology. 2010;112(3):607–13. doi:.
  20. Petronio AS, Giannini C, De Carlo M, Bedogni F, Colombo A, Tamburino C, et al. Anaesthetic management of transcatheter aortic valve implantation: results from the Italian CoreValve registry. EuroIntervention. 2016;12(3):381–8. doi:.
  21. Di Mario C, Eltchaninoff H, Moat N, Goicolea J, Ussia GP, Kala P, et al.; Transcatheter Valve Treatment Sentinel Registry (TCVT) Investigators of the EURObservational Research Programme (EORP) of the European Society of Cardiology. The 2011-12 pilot European Sentinel Registry of Transcatheter Aortic Valve Implantation: in-hospital results in 4,571 patients. EuroIntervention. 2013;8(12):1362–71. doi:.
  22. Lauck SB, Wood DA, Baumbusch J, Kwon JY, Stub D, Achtem L, et al. Vancouver Transcatheter Aortic Valve Replacement Clinical Pathway: Minimalist Approach, Standardized Care, and Discharge Criteria to Reduce Length of Stay. Circ Cardiovasc Qual Outcomes. 2016;9(3):312–21. doi:.
  23. Wood DA, Lauck SB, Cairns JA, Humphries KH, Cook R, Welsh R, et al. The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study. JACC Cardiovasc Interv. 2019;12(5):459–69. doi:.
  24. Thiele H. SOLVE-TAVI: A 2x2 Randomized Trial of Self-Expandable vs Balloon-Expandable Valves and General vs Local Anesthesia in Patients Undergoing Transcatheter Aortic Valve Implantation. Transcatheter Cardiovascular Therapeutics; 2018 September 21–25; San Diego, CA.
  25. Barbanti M, van Mourik MS, Spence MS, Icovelli F, Martinelli GL, Muir DF, et al. Optimizing Patient Discharge Management after Transfemoral Transcatheter Aortic Valve Implantation: The Multicentre European FAST-TAVI Trial. EuroIntervention. 2019. [Epub ahead of print] doi:.
  26. Lefevre F, Feinglass J, Potts S, Soglin L, Yarnold P, Martin GJ, et al. Iatrogenic complications in high-risk, elderly patients. Arch Intern Med. 1992;152(10):2074–80. doi:.
  27. George AJ, Boehme AK, Siegler JE, Monlezun D, Fowler BD, Shaban A, et al. Hospital-Acquired Infection Underlies Poor Functional Outcome in Patients with Prolonged Length of Stay. ISRN Stroke. 2013;2013:312348. doi:.

Most read articles by the same author(s)

1 2 > >>