-
Early mobilisation (ambulation 4–6 h post-procedure) is feasible after contemporary lower-risk transfemoral transcatheter aortic valve implantation (TF-TAVI).
-
Early ambulation, after strictly selecting eligible TF-TAVI patients, was associated with a similar rate of vascular complications when compared to the standard protocol (supine bed rest until the next morning).
-
Early ambulation after TF-TAVI lowers the combined incidence of delirium, infections, pain and unplanned urinary catheter use.
-
It may be beneficial to adopt early mobilisation into contemporary TF-TAVI practice.
Introduction
Methods
Inclusion criteria
Procedure and vascular closure
Patient eligibility and treatment allocation
Outcomes
Statistical analysis
Results
Study population and patient eligibility
EARLY (n = 73) | REGULAR (n = 77) | p-value | |
---|---|---|---|
Age | 78.92 ± 10.9 | 80.47 ± 6.2 | 0.624 |
Men | 40 (55%) | 32 (42%) | 0.105 |
BMI | 27.1 ± 4.8 | 28.3 ± 6.0 | 0.183 |
AVA | 0.78 ± 0.18 | 0.80 ± 0.19 | 0.567 |
Peak AV gradient | 65 ± 25 | 62 ± 20 | 0.404 |
STS-PROM | 3.522 ± 1.845 | 4.028 ± 1.818 | 0.092 |
EuroSCORE II | 2.72 ± 1.55 | 3.71 ± 2.14 | 0.001 |
DM | 23 (32%) | 27 (35%) | 0.644 |
COPD | 8 (11%) | 12 (16%) | 0.405 |
AF | 27 (37%) | 22 (29%) | 0.272 |
Previous CABG | 3 (4%) | 8 (10%) | 0.147 |
Previous PCI | 13 (18%) | 22 (29%) | 0.130 |
Previous stroke | 6 (8%) | 8 (10%) | 0.667 |
Previous PM | 8 (11%) | 4 (5%) | 0.193 |
Creatinine (µmol/l) | 94 ± 43 | 108 ± 60 | 0.124 |
eGFR | 61 ± 17 | 54 ± 16 | 0.011 |
Procedural characteristics
EARLY (n = 73) | REGULAR (n = 77) | p-value | |
---|---|---|---|
SAPIEN 3 | 68 (93.2%) | 74 (96.1%) | 0.309 |
Valve size distribution (20/23/26/29 mm)a | 0/24/25/13 | 2/32/29/10 | 0.367 |
Arterial closure valve side (double Proglide/single Proglide/Manta/Prostar) | 62/1/5/5 | 66/2/2/7 | 0.550 |
Arterial closure non-valve side (single Proglide/Angioseal/none) | 30/41/2 | 35/40/2 | 0.865 |
Time to mobilisation | 4 h 49 min ± 31 min | 20 h 7 min ± 3 h 6 min | <0.0001 |
Primary endpoint: | |||
Major vascular complications | 0 | 0 | – |
Major bleeding complications | 0 | 0 | – |
Minor vascular complications | 4 (5.5%) | 6 (7.8%) | 0.570 |
Minor bleeding | 4 (5.5%) | 6 (7.8%) | 0.570 |
Secondary endpoints: | |||
Painb | 4 (5.5%) | 8 (10.4%) | 0.218 |
Infection | 2 (2.7%) | 3 (3.9%) | 0.693 |
Delirium | 1 (1.4%) | 2 (2.6%) | 0.591 |
Unplanned urinary catheter use | 3 (4.1%) | 8 (10.4%) | 0.140 |
– Combined endpointc | 9 (12.3%) | 20 (26.0%) | 0.034 |
Prolonged hospitalisationd | 30 (41.1%) | 40 (51.9%) | 0.183 |
Duration of hospital stay (median days [IQR]) | 3 (2–5) | 4 (2–6) | 0.243 |