The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study.

Journal Article (Journal Article;Multicenter Study)

OBJECTIVES: The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway. BACKGROUND: Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, hospital stays average at least 6 days in most trials. The Vancouver 3M Clinical Pathway is focused on next-day discharge, made possible by the use of objective screening criteria as well as streamlined peri- and post-procedural management guidelines. METHODS: Patients were enrolled from 6 low-volume (<100 TAVR/year), 4 medium-volume, and 3 high-volume (>200 TAVR/year) centers in Canada and the United States. The primary outcomes were a composite of all-cause death or stroke by 30 days and the proportion of patients successfully discharged home the day following TAVR. RESULTS: Of 1,400 screened patients, 411 were enrolled at 13 centers and received a SAPIEN XT (58.2%) or SAPIEN 3 (41.8%) valve (Edwards Lifesciences, Irvine, California). In centers enrolling exclusively in the study, 55% of screened patients were enrolled. The median age was 84 years (interquartile range: 78 to 87 years) with a median STS score of 4.9% (interquartile range: 3.3% to 6.8%). Next-day discharge home was achieved in 80.1% of patients, and within 48 h in 89.5%. The composite of all-cause mortality or stroke by 30 days occurred in 2.9% (95% confidence interval: 1.7% to 5.1%), with neither component of the primary outcome affected by hospital TAVR volume (p = 0.51). Secondary outcomes at 30 days included major vascular complication 2.4% (n = 10), readmission 9.2% (n = 36), cardiac readmission 5.7% (n = 22), new permanent pacemaker 5.7% (n = 23), and >mild paravalvular regurgitation 3.8% (n = 15). CONCLUSIONS: Adherence to the Vancouver 3M Clinical Pathway at low-, medium-, and high-volume TAVR centers allows next-day discharge home with excellent safety and efficacy outcomes.

Full Text

Duke Authors

Cited Authors

  • Wood, DA; Lauck, SB; Cairns, JA; Humphries, KH; Cook, R; Welsh, R; Leipsic, J; Genereux, P; Moss, R; Jue, J; Blanke, P; Cheung, A; Ye, J; Dvir, D; Umedaly, H; Klein, R; Rondi, K; Poulter, R; Stub, D; Barbanti, M; Fahmy, P; Htun, N; Murdoch, D; Prakash, R; Barker, M; Nickel, K; Thakkar, J; Sathananthan, J; Tyrell, B; Al-Qoofi, F; Velianou, JL; Natarajan, MK; Wijeysundera, HC; Radhakrishnan, S; Horlick, E; Osten, M; Buller, C; Peterson, M; Asgar, A; Palisaitis, D; Masson, J-B; Kodali, S; Nazif, T; Thourani, V; Babaliaros, VC; Cohen, DJ; Park, JE; Leon, MB; Webb, JG

Published Date

  • March 11, 2019

Published In

Volume / Issue

  • 12 / 5

Start / End Page

  • 459 - 469

PubMed ID

  • 30846085

Electronic International Standard Serial Number (EISSN)

  • 1876-7605

Digital Object Identifier (DOI)

  • 10.1016/j.jcin.2018.12.020


  • eng

Conference Location

  • United States