Clinical yield of discharge transthoracic echocardiography in transcatheter aortic valve implantation patients from a contemporary cohort
O Ward, A Alhakak, E L Brogaard, T S Soerensen, L M Soerensen, J E Strange, A A Raja, O De Backer, L Kober, J J Linde, E L FosbolAbstract
Background
Transcatheter aortic valve implantation (TAVI) procedural volumes are increasing, and advances in technology have contributed to lower complication rates and shorter hospitalizations. After TAVI, routine transthoracic echocardiography (TTE) is still performed before discharge and repeated at 3-month follow-up in Denmark. However, the clinical yield of discharge TTE has not been examined systematically.
Purpose
To examine the clinical yield of post-procedure, pre-discharge echocardiography in TAVI patients from a contemporary cohort.
Methods
We included all patients who underwent TAVI in Eastern Denmark in 2023–2024. The population was stratified by simple (tricuspid valve, transfemoral access) vs complex procedures (bicuspid valve, valve-in-valve, or alternative access). The discharge TTE was defined as clinically relevant if it led to one of the following: 1) additional early follow-up TTE; 2) new transoesophageal echocardiography for further valve assessment; 3) reintervention; 4) or if it revealed post procedural fall in LVEF to <40%.
Results
A total of 894 patients were included (62.1% male; median age 80.0 years [IQR 76.5–83.7]), of whom 723 (80.9%) underwent a simple procedure and 171 (19.1%) a complex procedure. Patients who underwent a simple procedure were older than those who underwent a complex procedure (80.6 vs 78.0 years; P<0.001). Overall, comorbidities were similar between groups. Clinically relevant findings were detected in 25 (2.8%) patients: 16 (2.2%) in the simple group vs 9 (5.3%) in the complex group (P=0.03). Among these 25 patients, TTE led to additional follow-up TTE in 12 (48%), transoesophageal echocardiography for further valve assessment in 6 (24%), referral to a heart failure clinic in 6 (24%) (due to LVEF drop to <40%), and reintervention in one (4%) patient (Figure).
Conclusion
In a contemporary TAVI cohort, approximately 3% of patients had a clinically relevant TTE finding that prompted further investigation. Among these, 6 patients were referred to a heart failure clinic and one patient underwent reintervention. These findings suggest limited overall clinical yield of routine discharge echocardiography after TAVI.