Abstract 11419: Outcomes of Transcatheter Aortic Valve Replacement in Patients with High Comorbidity versus Low Comorbidity Burden

Abstract

Introduction: Transcatheter aortic valve replacement (TAVR)’s on-par performance with surgical aortic valve replacement in clinical trials has led to its successful adoption in patients with high and low mortality risk. Here we evaluate if a correlation exists between comorbidity burden and in-hospital mortality (IHM) in TAVR patients and examine the factors associated with increased IHM. Methods: Using the National Inpatient Sample database, 148,315 adult patients who underwent TAVR from 2016 through 2018 were included in the study. The Elixhauser Comorbidity Index 2020 was used to identify comorbidities. All comorbidities were weighted equally. Patients with <3 comorbidities were assigned to the low comorbidity group (LCG) and those with ≥3 comorbidities to the high comorbidity group (HCG). The primary outcome of interest was IHM in the HCG versus the LCG. Secondary outcomes were average length of stay (LOS) and average hospital charges. Results: The overall IHM rate in our sample was 1.52%. Unadjusted and adjusted IHM odds were not different between groups (unadjusted odds ratio=1.024, P=0.7994; adjusted odds ratio=1.022, P=0.8225). Female sex, non-elective admission for TAVR, and transapical access were found to be independent predictors of IHM when adjusted for other factors (Table). The adjusted average LOS was significantly higher in the HCG than the LCG (3.07 vs. 2.7 days, P<0.0001). The adjusted average total hospital charges billed and average actual cost of hospital services were significantly higher in the HCG than the LCG (213,507 vs 208,019 USD, P=0.0032 and 55,284 vs 54,278 USD, P=0.0078; respectively). Conclusion: In-hospital mortality in TAVR patients is not significantly correlated with comorbidity burden. Female sex and procedural characteristics like transapical access and non-electiveness are more important in determining IHM. Resource utilization is higher in the HCG than the LCG.