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28-02-2020 | Original Article | Uitgave 5/2020 Open Access

Netherlands Heart Journal 5/2020

Early mobilisation after transfemoral transcatheter aortic valve implantation: results of the MobiTAVI trial

Tijdschrift:
Netherlands Heart Journal > Uitgave 5/2020
Auteurs:
J. Vendrik, W. Vlastra, M. S. van Mourik, R. Delewi, M. A. Beijk, J. Lemkes, J. J. Wykrzykowska, R. J. de Winter, J. S. Henriques, J. J. Piek, M. M. Vis, K. T. Koch, J. Baan Jr.
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12471-020-01374-5) contains supplementary material, which is available to authorized users.

Abstract

Background

Immobilisation of patients after transfemoral transcatheter aortic valve implantation (TF-TAVI) is the standard of care, mostly to prevent vascular complications. However, immobilisation may increase post-operative complications such as delirium and infections. In this trial, we determine whether it is feasible and safe to implement early ambulation after TF-TAVI.

Methods

We prospectively included TF-TAVI patients from 2016 to 2018. Patients were assessed for eligibility using our strict safety protocol and were allocated (based on the time at which the procedure ended) to the EARLY or REGULAR group.

Results

A total of 150 patients (49%) were deemed eligible for early mobilisation, of which 73 were allocated to the EARLY group and 77 to the REGULAR group. The overall population had a mean age of 80 years, 48% were male with a Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score of 3.8 ± 1.8. Time to mobilisation was 4 h 49 min ± 31 min in the EARLY group versus 20 h 7 min ± 3 h 6 min in the REGULAR group (p < 0.0001). There were no differences regarding the primary endpoint. No major vascular complications occurred and a similar incidence of minor vascular complications was seen in both groups (4/73 [5.5%] vs 6/77 [7.8%], p = 0.570). The incidence of the combined secondary endpoint was lower in the EARLY group (p = 0.034), with a numerically lower incidence for all individual outcomes (delirium, infections, pain and unplanned urinary catheter use).

Conclusion

Early mobilisation (ambulation 4–6 h post-procedure) of TF-TAVI patients is feasible and safe. Early ambulation decreases the combined incidence of delirium, infections, pain and unplanned urinary catheter use, and its adoption into contemporary TAVI practice may therefore be beneficial.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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