Very-Early Discharge After Transcatheter Aortic Valve Replacement: Updated Systematic Review and Meta-Analysis of Contemporary Readmission and Clinical Outcomes

Very-early discharge after transcatheter aortic valve replacement (TAVR) is increasingly incorporated into contemporary care pathways, but comparative outcomes remain vulnerable to clinical selection and reverse causation. We aimed to evaluate contemporary readmission and clinical outcomes associated with very-early versus later discharge after TAVR. The Medical Literature Analysis and Retrieval System Online via PubMed and the Cochrane Central Register of Controlled Trials were searched from inception through June 2026. Comparative studies evaluating same-day discharge, next-day discharge, discharge within 24 hours, hospital length of stay of 1 day or less, or corresponding institutional strategies were eligible. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using inverse-variance random-effects models. Thirteen observational studies were included; 12 contributed crude binary data from up to 24,984 patients. Very-early discharge was associated with lower 30-day all-cause readmission (OR, 0.74; 95% CI, 0.67–0.82), early mortality (OR, 0.40; 95% CI, 0.30–0.54), and stroke or cerebrovascular events (OR, 0.58; 95% CI, 0.45–0.76). Delayed or post-discharge permanent pacemaker implantation was inconclusive. The readmission association became nonsignificant after the exclusion of the largest study. Certainty ranged from very low to low. Very-early discharge was associated with favorable outcomes in selected cohorts, but serious bias and influential studies preclude causal or universal conclusions. Structured, criteria-based pathways require rigorous prospective validation and standardized follow-up across diverse contemporary clinical settings.