Moad El-Haddad

Background: Patients undergoing urgent transcatheter aortic valve implantation (TAVI) represent a clinically high-risk population with increased peri-procedural morbidity. Whether an early discharge strategy is feasible and safe remains unclear. We evaluated the feasibility of early discharge in patients undergoing urgent transcatheter aortic valve implantation. Methods: This single-centre observational cohort study included 279 consecutive patients undergoing urgent TAVI (mean age 81 ± 7 years; 155 [56%] male). Patients were stratified according to post-TAVI length of stay into next-day discharge or prolonged hospitalisation (>1 day). Data were prospectively collected and the primary end point was 30-day all-cause mortality. Results: Among 279 urgent TAVI patients, 62 (22%) were discharged the next day and 217 (78%) had prolonged hospitalisation. Baseline clinical and echocardiographic characteristics were similar between the two groups. Among the 279 patients surviving to discharge assessment, 30-day mortality was 0.4%, with no significant difference between the next-day and longer-stay groups. Patients in the short hospital stay group had an 11% complication rate compared to 30% in the long stay one. Unlike stroke or pacemaker implantation, vascular complication was an independent predictor of extended in-hospital length of stay [Beta coefficient 3.41, 95% CI (0.98 to 5.85), p = 0.006]. Conclusions: Next-day discharge appears feasible in carefully selected patients undergoing urgent TAVI and was not associated with excess 30-day mortality in this observational cohort. Prospective multi-centre studies are required to validate these findings and establish standardised discharge criteria.

Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) is a rare coronary artery anomaly which accounts for 0.25–0.5% of all congenital cardiac diseases, where most die within the first year of life. We present a case report of a 50-year-old lady who presented to hospital with persistent palpitations. Her admission electrocardiogram found her to be in Atrial Fibrillation (AF). She was rate-controlled and subsequently discharged. Despite that, she represented with further episodes of AF and was referred for an outpatient transthoracic echocardiogram. This revealed a dilated right coronary artery, retrograde flow in the left coronary artery and collateral flow in the myocardium. To investigate, the patient had undergone further imaging which confirmed the diagnosis. As such, she was later shortlisted for surgical intervention. Conclusively, our case exemplifies the role of multimodal imaging to identify the features of ALCAPA and may be useful for the purposes of surgical intervention.