Same day discharge after structural heart disease interventions in the era of the coronavirus-19 pandemic and beyond

Table 1 Proposed pre-requisites for same day discharge in structural cardiac procedures

Pre-procedure

Administrative buy-in

Experienced operator

Same day discharge multi-disciplinary team including social workers and nursing

Elective procedure

Reliable means for follow-up

Patient without significant co-morbidities

Willing to depart on the same day

Adequate social support

During procedure

Intra-Procedural monitoring without significant hemodynamic compromise

Successful vascular access without immediate complications

Successful deployment of device

Right atrial pacing for TAVR without wenkebach

Post-procedure

Hemodynamic monitoring for 4-6 h without instability

Able to mobilize without assistance

Vascular access site integrity

TTE without significant pericardial effusion

No new AV block or inter-ventricular conduction delays

Prescriptions arranged

Evening phone call from provider

Next day in-person follow up for imaging and laboratory investigations

AV: Atrioventricular; TAVR: Transcatheter aortic valve replacement; TTE: Transthoracic echocardiogram.

Table 2 Summary of Studies with same day discharges for structural heart disease procedures

Ref.	Year	Procedure	Same day discharge, n	Outcome
Gilhofer et al[13]	2020	LAAO	24	No significant difference in overall events between SDD and non SDD
Tan et al[14]	2021	LAAO	72	No significant difference in 7 and 45 d outcomes between SDD and non SDD
Marmagkiolis et al[15]	2021	LAAO	112	No complications among patients that underwent SDD
Williams et al[16]	2018	LAAO	78	1 patient from the SDD group was readmitted within 7 d
Marmagkiolis et al[24]	2021	Mitra-clip	82	No intra-procedure complications, only 1 patient had minor access site hematoma
Chen et al[25]	2020	Mitra-clip	1	No post procedure complication
Perdoncin et al[6]	2021	TAVR	29	No in hospital complications, no 30 d deaths
Russo et al[31]	2020	TAVR	3	No deaths or re-admissions within 24 d of procedure
Rai et al[32]	2021	TAVR	6	No immediate complications or events on 7 d rhythm monitor
Ponnuthurai et al[44]	2009	PFO/ASD	48	One Patient with groin hematoma immediately after procedure
Barker et al[45]	2020	PFO/ASD	455	No significant difference in death, 30 d readmission, device thrombosis, and stroke/TIA

ASD: Atrial septal defect; LAAO: Left atrial appendage occlusion; PFO: Patent foramen ovale; SDD: Same day discharge; TAVR: Transcatheter aortic valve replacement; TIA: Transient ischemic attack.