Effect of eliminating pre-discharge transthoracic echocardiogram on outcomes after TAVR

Garrett A. Welle, Bassim El-Sabawi, Jeremy J. Thaden, Kevin L. Greason, Kyle W. Klarich, Vuyisile T. Nkomo, Mohamad A. Alkhouli, Mayra E. Guerrero, Juan A. Crestanello, Rajiv Gulati, Charanjit S. Rihal, Mackram F. Eleid

Research output: Contribution to journalArticlepeer-review


Objectives: The aim of this study was to determine the safety of eliminating the pre-discharge transthoracic echocardiogram (TTE) on 30-day outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Background: TTE is utilized before, during, and after TAVR. Post-procedural, pre-discharge TTE assists in assessment of prosthesis function and detection of clinically significant paravalvular leak (PVL) after TAVR. Methods: Patients who underwent TAVR at Mayo Clinic from July 2018 to July 2019 were included in a prospective institutional registry. Patients undergoing TAVR prior to February 2019 received a pre-discharge TTE, while those undergoing TAVR after February 2019 did not. Both cohorts were evaluated with TTE at 30 days post-TAVR. Results: A total of 330 consecutive patients were included. Of these, 160 patients (age 81.1 ± 7.6) had routine pre-discharge TTE, while 170 patients (age 78.9 ± 7.5) were dismissed without routine pre-discharge TTE. Mortality at 30 days was similar between the two groups (0% and 1.2%, respectively). One episode of PVL requiring intervention (0.6%) occurred in the pre-discharge TTE group and none in the group without pre-discharge TTE at 30-day follow-up. There was a similar incidence of total composite primary and secondary adverse events between the cohort receiving a pre-discharge TTE and those without (28.1% vs. 25.3%, P = 0.56) at 30 days. The most common event was need for permanent pacemaker or ICD implantation in both groups (13.1% vs. 11.8%, P = 0.71). Conclusions: Elimination of the pre-discharge TTE is safe and associated with comparable 30-day outcomes to routine pre-discharge TTE. These findings have implication for TAVR practice cost-efficiency and health care utilization.

Original languageEnglish (US)
Pages (from-to)861-866
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Issue number3
StatePublished - Feb 15 2022


  • aortic valve disease
  • paravalvular leak
  • percutaneous valve therapy
  • transcatheter valve implantation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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