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Streamlining Post-Procedural care for Patients Undergoing M- and T-TEER

https://doi.org/10.1007/s00392-024-02526-y

Jan Baucks (Kiel)1, J. C. Voran (Kiel)2, L. Maiwand (Kiel)2, J. Frank (Kiel)2, T. Kujat (Kiel)2, H. Seoudy (Kiel)2, M. Saad (Kiel)2, D. Frank (Kiel)1, F. Kreidel (Kiel)2

1Universitätsklinikum Schleswig-Holstein Innere Medizin III mit den Schwerpunkten Kardiologie und internistische Intensivmedizin Kiel, Deutschland; 2Universitätsklinikum Schleswig-Holstein Innere Medizin III mit den Schwerpunkten Kardiologie, Angiologie und internistische Intensivmedizin Kiel, Deutschland

 

Background: Transcatheter edge-to-edge repair (TEER) is increasingly used in patients with mitral or tricuspid regurgitation who are at high risk for open-heart surgery and is usually performed under general anaesthesia. Post-procedural care for these patients is typically provided in either Intensive Care (ICU) or Intermediate Care Units (IMC). To conserve resources, we decided to evaluate bypassing ICU/IMC by transferring patients directly to a regular ward after a short monitoring in a regular holding area, as similar streamlining had been effective for patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: We retrospectively analysed a total of 209 consecutive patients undergoing TEER for either mitral- or tricuspid valves at our centre. Of these, 115 patients were treated before the change in postprocedural care was introduced (ICU/IMC group) and 94 patients were treated afterwards (streamlined group). We sought to investigate differences in length of stay and time spent on IMC/ICU. The primary safety endpoint was all-cause mortality within the first 6 months after TEER. Patients admitted to the ICU/IMC prior to the procedure or with an emergency indication were excluded from the study.

Results: Mean age was 74±7 years, 43% were female. There was no sig. difference in between the two groups reg. age, gender, baseline characteristics, lesion severity, medication and lab values including NTproBNP. In the normal ward group x patients were transferred to IMC, x to ICU unplanned. The post-procedural length of hospital stay was significantly shorter in the streamlined gropu (median 3728 vs. 3067 min[FK3] ; p=0,015). All-cause mortality within the first 6 months did not differ significantly in the two groups (x% vs. y%; p=0.03). Also bleeding events were not more common in the streamlined group (3% vs. 1%; p=0.9).

Conclusions: Bypassing ICU/IMC after M- and T-TEER significantly reduced resource allocation and length of hospital stay without compromising patient safety.

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