LAUSR

Background: Standard of care for elective structural heart disease (SHD) procedures have included at least one overnight stay in the hospital. Same day discharge (SDD) after PCI has been well studied with no difference in cardiovascular outcomes, repeat hospitalizations, or overall complications with SDD following PCI. With the ongoing COVID pandemic, there are several patients and family members who prefer to go home same day to avoid exposure. SDD after structural heart procedures such as valve repair/replacements, Watchman device implantations is not well studied. There are no recommendations on how to do this in a safe and effective way. After rigorous planning, we designed a protocol to assess the safety and feasibility of SDD after structural interventions in selected patients. Methods: A total of 114 patients undergoing elective SHD interventions between July 2020 till November 2021 who opted to go home on the same day in view of the ongoing pandemic were included in the study. These patients had good social support, met our centers safety protocol, TVT registry requirements, lab, and ambulation criteria. We assessed the demographics, safety, and outcomes. Results: Of the 114 patients, 37 underwent transfemoral TAVR, 2 BAV, 8 TEER, 2 transcatheter mitral valve in valve, 48 Watchman and 17 ASD/PFO closure. The mean age was 72.2 years (32 - 89y). The mean creatinine was 1.23 ( 0.6 - 2.6). General anesthesia was used in 96, conscious sedation in 17 and local anesthesia only in one. The mean contrast usage was 64 ml of visipaque (0 - 129 ml). The mean procedure time was 32 min(14 -121min). All patients were ambulated at least twice. The first within 2 hours of procedure and 2nd before discharge. There was no electrical block noted during anytime in the procedural or periprocedural period. The mean length of stay was 8.1 hours(4 - 16.8h). All patients received a cell number to call in case of any concerns and for easy access. All patients received a call in the evening on the same day and on the next day morning. There were no readmissions, bleeding episodes, acute kidney injury or deaths till last follow up. Conclusions: 1. Selective, same-day discharge after TF TAVR, Transcatheter Mitral valve in valve replacements, TEER, Watchman and ASD/PFO closures is safe and feasible and may be considered in patients who opt for it and have a good social fabric. 2. Patients did not enter the Hospital floor/ICU 3. SDD improves patient satisfaction and increases hospital bed availability, importantly in the ongoing pandemic. 4. SDD has enormous potential to reduce overall health care costs.