Thread by @DeveshRaiMD

When do you typically discharge your patients post-TAVR?

Check out the 🧵 below for a #tweetorial about same-day discharge following #TAVR!

@tavrkapadia @Edwards_TAVR @TAVRBot @cardioPCImom @SripalBangalore @SrihariNaiduMD @Pooh_Velagapudi @ehj_ed @DLBHATTMD @JPDeptaMD

After this thread 🧵, you'll:

✅Recognize common complications🩺 after TAVR

✅Understand the feasibility of Same-Day Discharge (#SDD) and predictors of Next Day Discharge (NDD) after TAVR.

@CCIJournal #TAVR @WaqasTahir

I feel comfortable🙂 identifying patients who can be discharged🚑 on the same-day after TAVR?

The #COVID pandemic has changed our practices in multiple ways.

#SDD can help in preventing prolonged hospital exposure for the patients.

Post-procedure complications are significant barriers to #SDD, and need to be recognized! What are they❓

The common complication of #TAVR are:

1⃣Bleeding from the access site
2⃣New-onset LBBB
3⃣CHB
4⃣Stroke
5⃣Coronary occlusion
6⃣Contrast associated nephropathy

Conduction Abnormalities are very common. So how you may quickly predict if your patient may require a PPM?

A @ClevelandClinic study showed post-TAVR rapid atrial pacing (RAP) has 99% NPV for pacemaker implantation:

So, RAP may help risk-stratify patients in the management of post-TAVR conduction disturbances.

How'd they do this❓

Briefly, for post-TAVR we place a temporary pacer in the RV🫀. The authors moved it to the RA ➡️paced the atria up to 120 bpm and if no Wenckebach AVB➡️ highly predictive of not🚫 needing a PPM!

bit.ly/3sUmPI7

What else should we consider❓

A @TallRoundsTM @CleveClinicCath study compared predictors of NDD (Next Day DC) vs. Non-NDD

Predictors of NDD were male♂️, relatively younger age (less than 90), absence of atrial fibrillation, and lower serum Cr)

We report case series of 6 patients #SDD post-TAVR. Pts underwent RAP to risk stratify.

3 hrs➡️➡️ post-TAVR all patients were ambulated🚶‍♀️🚶‍♂️ multiple times to ensure an intact vascular access site.

Post-TAVR, vascular complications are one of the major barriers to discharge.

As mentioned, new-onset conduction abnormalities are a big barrier to DC post-TAVR.

Commonly pts are monitored inpatient🏥🛏️ 1-3 days on telemetry for complications

We instead used real-time remote cardiac monitoring post-discharge to monitor for conduction abnormalities.

In the case of any new-onset conduction abnormalities, patients could be contacted promptly and assessed. 🚑🩺🏩

A detailed report is available from real-time monitoring, and the patients were monitored up to 14 days via remote monitoring.

When selecting pts for possible SDD, our pts had similar characteristics as the @CleveClinicCath Study of NDD and were ambulatory w/ good social support.🚶‍♀️🚶

Here is our protocol for considering #SDD post-TAVR.

@JPDeptaMD @DLBHATTMD @WaqasTahir @InstituteSands

In another study from @emoryheart @EmoryCCRI, they developed a protocol for SDD after #TAVR @CCI

Patients not meeting the following criteria were considered for #SDD.

So let's summarize!

✅Complications of #TAVR are barriers to Early DC🧑‍🦽

✅RAP may predict who DOESN'T need a PPM after #TAVR

✅There are protocols for safe #SDD after #TAVR!

I learned something in this #Tweetorial that may change my clinical practice.

Many thanks🙏 to @ThomasMDas @Cardionerds @karanpdesai Academy for their feedback and support!

Thanks to @AmitGoyalMD and @Dr_DanMD for democratizing CV🫀 education and bringing all @cardionerds together.

I feel comfortable identifying patients who can be discharged on the same day after TAVR?