{"id":"eb536ba82cfa","type":"article","url":"https://hartvaat.nl/2026/09/12/ambulant-tavi-pad-verkort-hospitalisatieduur-bij-ernstige-aortaklepstenose/","title":"Ambulant TAVI-pad verkort hospitalisatieduur bij ernstige aortaklepstenose","title_en":"Ultra-rapid outpatient treatment of patients with severe aortic stenosis presenting with acute valve syndrome: evaluation of a novel pathway for urgent TAVI.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Open heart","doi":"10.1136/openhrt-2026-004222","source_url":"https://doi.org/10.1136/openhrt-2026-004222","authors":["Jonathan Vibhishanan","Kate Winn","Joao Ferreira-Martins","Harish Sharma","Ali Hosin","Katie Konstanciak","Joana Matos Dias","Joao Gurreiro De Almeida","Claudia Hundertmark","Samantha Bulman","James N Fullerton","Sam Dawkins","Russell Franks","Rajesh K Kharbanda","James D Newton","Adrian P Banning","Thomas J Cahill"],"significance":5,"published":"2026-09-21","source_date":"2026-09-12","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/aortastenose/","https://hartvaat.nl/kennis/kleplijden/aortaregurgitatie/"],"congress":"","summary_en":"A single-centre cohort study evaluated an ultra-rapid outpatient pathway for selected patients with severe aortic stenosis presenting with acute valve syndrome. Patients meeting criteria were discharged home to complete work-up and undergo TAVI within two weeks. The outpatient group had a significantly shorter total hospital stay (median 12 vs 20 days, p<0.0001) with no increase in pre-TAVI death or acute decompensation. This approach offers a safe and efficient strategy to reduce hospital bed occupancy and length of stay without compromising patient safety.","created":"2026-09-14T01:14:50Z","updated":"2026-09-14T01:14:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een eencentrum-cohortstudie onderzocht de haalbaarheid en veiligheid van een versneld ambulante TAVI-route voor geselecteerde patiënten met ernstige aortaklepstenose en acute decompensatie. Patiënten die aan de criteria voldeden, werden ontslagen voor afhandeling van het diagnostisch traject en behandeling binnen twee weken. De ambulante groep had een kortere totale hospitalisatieduur (12 versus 20 dagen, p<0,0001) zonder toename van overlijden of acute decompensatie voorafgaand aan de ingreep. Dit ambulante pad biedt een veilige en efficiënte optie om hospitalisatieduur en beddenbezetting te reduceren bij geselecteerde AVS-patiënten.","abstract_original":"BACKGROUND: Up to 30% of patients undergoing transcatheter aortic valve implantation (TAVI) have presented to hospital with acute decompensation of aortic stenosis (acute valve syndrome, (AVS)). Such patients conventionally undergo inpatient work-up and treatment by TAVI, associated with prolonged hospital stays, deconditioning and delayed recovery. This study aimed to evaluate the impact and feasibility of an ultra-rapid outpatient pathway for selected, stabilised AVS patients undergoing treatment by TAVI. METHODS: This single-centre cohort study with preimplementation and postimplementation comparison included consecutive AVS patients referred for TAVI over 6 months pre-pathway implementation and 12 months post-pathway implementation. Those meeting prespecified criteria were discharged home for completion of work-up and treatment by TAVI within 2 weeks. The primary efficacy endpoint was length of hospital stay. The primary safety endpoint was death or acute decompensation prior to TAVI. RESULTS: 183 patients were included, of which 105 were evaluated for outpatient treatment after ultra-rapid pathway introduction. 58/105 (55.2%) met criteria for outpatient treatment, the remaining 47/105 (44.8%) were managed as inpatients. There was no significant difference in demographic or echocardiographic characteristics between management pathways. Patients treated as an outpatient had a shorter median total length of hospital stay (outpatient 12 days (IQR 7-17) vs inpatient 20 days (IQR 15-32), p<0.0001), saving an estimated 210 hospital bed-days. There was no significant difference in median time from referral to TAVI (outpatient 15 days (IQR 13-20) vs inpatient 14 days (IQR 10-18), p=0.22), nor in the incidence of the safety endpoint prior to TAVI between pathways (outpatient 6.9% vs inpatient 6.4%, HR 0.97, 95% CI 0.22 to 4.34, p=0.97), or after new pathway implementation (pre-pathway 6.7%, post-pathway 6.7%, HR 0.70, 95% CI 0.17 to 2.80, p=0.61). CONCLUSIONS: An ultra-rapid outpatient pathway for selected AVS patients undergoing treatment by TAVI can successfully reduce total length of hospital stay. Further work is required to validate this approach."}