Timely hospital discharge in TAVI patients: towards a patient-centered care pathway

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Abstract
Transcatheter aortic valve implantation (TAVI) has evolved into the dominant therapeutic option for severe aortic stenosis, with procedural refinements and expanding indications increasingly supporting shorter post-procedural monitoring and discharge. International evidence from randomized trials, multi-center registries, and consensus guidelines demonstrates that reduced length of stay (LOS), including next-day or early discharge, can be safely achieved in selected patients when supported by standardized workflows, careful patient selection, and structured outpatient monitoring. In Germany, LOS remains among the longest in Europe, driven by structural, reimbursement, and cultural barriers. With increasing TAVI volumes, demographic pressures, and workforce constraints, these barriers inhibit health system sustainability, procedural capacity, and patient experience. Early discharge below the currently defined thresholds often results in financial disadvantages under the Diagnosis-Related Group (DRG) reimbursement mechanism, thereby disincentivizing standardized adoption and pathway innovation. Yet, a reduction in LOS would yield meaningful system-level advantages, including increased procedural capacity, improved resource allocation, and lower post-procedural bed occupancy costs, all leading to better and more efficient patient pathways. This narrative, practice- and policy-oriented critical perspective evaluates the current German landscape and outlines pragmatic strategies to enable safe early discharge. It synthesizes relevant international evidence, identifies system-level barriers specific to Germany, and proposes a structured roadmap including: (1) standardized eligibility criteria, (2) protocolized peri- and post-procedural pathways, (3) pilot implementation in carefully selected centers with outcome reporting, and (4) reimbursement realignment to avoid wrong financial incentives. Supported by professional medical societies and aligned with international standards, early discharge pathways could enhance efficiency and improve patient-centered care, offering Germany a timely opportunity to modernize TAVI experience and delivery. Graphical Abstract The alternative text for this image may have been generated using AI.
Funding Information
  • Edwards Lifesciences
  • Universitätsklinikum Schleswig-Holstein - Campus Kiel

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