{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:45:00Z","timestamp":1793331900203,"version":"4.5.0"},"reference-count":29,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"unspecified","delay-in-days":71,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,8,10]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u201317)\u2009vs inpatient 20 days (IQR 15\u201332), p&lt;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\u201320)\u2009vs inpatient 14 days (IQR 10\u201318), 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%\u2009CI 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%\u2009CI 0.17 to 2.80, p=0.61).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004222","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:30:24Z","timestamp":1789201824000},"page":"e004222","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Ultra-rapid outpatient treatment of patients with severe aortic stenosis presenting with acute valve syndrome: evaluation of a novel pathway for urgent TAVI"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0445-2181","authenticated-orcid":false,"given":"Jonathan","family":"Vibhishanan","sequence":"first","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Winn","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao","family":"Ferreira-Martins","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0525-3520","authenticated-orcid":false,"given":"Harish","family":"Sharma","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Hosin","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Konstanciak","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Matos Dias","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao","family":"Gurreiro De Almeida","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Hundertmark","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Bulman","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James N","family":"Fullerton","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Dawkins","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Franks","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh K","family":"Kharbanda","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D","family":"Newton","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian P","family":"Banning","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J","family":"Cahill","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"2026091201301810000_13.2.e004222.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw229"},{"key":"2026091201301810000_13.2.e004222.2","doi-asserted-by":"crossref","unstructured":"Praz F , Borger MA , Lanz J , et al . ESC\/EACTS Guidelines for the management of valvular heart disease: Developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2025. doi:10.1093\/eurheartj\/ehaf194","DOI":"10.1093\/eurheartj\/ehaf194"},{"key":"2026091201301810000_13.2.e004222.3","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000923"},{"key":"2026091201301810000_13.2.e004222.4","first-page":"189","article-title":"Outcomes of urgent versus nonurgent transcatheter aortic valve replacement","volume":"96","author":"Elbadawi","year":"2020","journal-title":"Catheter Cardiovasc Interv"},{"key":"2026091201301810000_13.2.e004222.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.03.002"},{"key":"2026091201301810000_13.2.e004222.6","unstructured":"Kharbanda R . UK transcatheter aortic valve implantation (TAVI) registry 2025 annual report. 2025. Available: https:\/\/www.nicor.org.uk\/national-cardiac-audit-programme\/transcatheter-aortic-valve-implantation-tavi [Accessed 3 Sep 2025]."},{"key":"2026091201301810000_13.2.e004222.7","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1161\/CIRCULATIONAHA.125.074251","article-title":"New Classification to Describe Clinical Presentation in Aortic Stenosis: Stable, Progressive, and Acute Valve Syndrome","volume":"151","author":"G\u00e9n\u00e9reux","year":"2025","journal-title":"Circulation"},{"key":"2026091201301810000_13.2.e004222.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.02.038"},{"key":"2026091201301810000_13.2.e004222.9","doi-asserted-by":"crossref","first-page":"101422","DOI":"10.1016\/j.cpcardiol.2022.101422","article-title":"Acute Decompensated Aortic Stenosis: State of the Art Review","volume":"48","author":"Patel","year":"2023","journal-title":"Curr Probl Cardiol"},{"key":"2026091201301810000_13.2.e004222.10","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1007\/s10741-023-10312-7","article-title":"Acute advanced aortic stenosis","volume":"28","author":"Avvedimento","year":"2023","journal-title":"Heart Fail Rev"},{"key":"2026091201301810000_13.2.e004222.11","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.38.1S5.V-61"},{"key":"2026091201301810000_13.2.e004222.12","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-71770-9","article-title":"Intensified ambulatory cardiology care: effects on mortality and hospitalisation-a comparative observational study","volume":"10","author":"Sawicki","year":"2020","journal-title":"Sci Rep"},{"key":"2026091201301810000_13.2.e004222.13","unstructured":"Beekman A . Answering questions about the shift in cardiology from inpatient to outpatient procedures. Available: https:\/\/www.shrm.org\/resourcesandtools\/hr-topics\/ [Accessed 28 Jan 2026]."},{"key":"2026091201301810000_13.2.e004222.14","first-page":"166","article-title":"Outcomes of emergency compared to elective TAVI: a meta-analysis","volume":"3","author":"Aparisi","year":"2023","journal-title":"RECICE"},{"key":"2026091201301810000_13.2.e004222.15","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1177\/00033197241245733","article-title":"Mortality Rates in Patients Undergoing Urgent Versus Elective Transcatheter Aortic Valve Replacement: A Meta-analysis","volume":"76","author":"Apostolos","year":"2025","journal-title":"Angiology"},{"key":"2026091201301810000_13.2.e004222.16","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzaf006"},{"key":"2026091201301810000_13.2.e004222.17","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1108\/17506121011095182","article-title":"Hospital length of stay and probability of acquiring infection","volume":"4","author":"Hassan","year":"2010","journal-title":"Intl J of Pharm & Health Mrkt"},{"key":"2026091201301810000_13.2.e004222.18","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/ggi.12471","article-title":"Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients","volume":"16","author":"Bo","year":"2016","journal-title":"Geriatr Gerontol Int"},{"key":"2026091201301810000_13.2.e004222.19","doi-asserted-by":"crossref","DOI":"10.3390\/geriatrics9060167","article-title":"Psychological Impact of Hospital Discharge on the Older Person: A Systematic Review","volume":"9","author":"Hussein","year":"2024","journal-title":"Geriatrics (Basel)"},{"key":"2026091201301810000_13.2.e004222.20","doi-asserted-by":"crossref","unstructured":"Ebinger JE , Gupta A , Huang TY , et al . Differential Characteristics and Outcomes of Urgent\/Emergent Versus Elective Aortic Valve Replacement. 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