Abstract 14995: Outcomes of Transcatheter Aortic Valve Replacements in Patients With Left Ventricular Assist Device

Abstract

Background: The development or progression of aortic insufficiency (AI) to moderate to severe in patients with left ventricular assist devices (LVADs) for end stage heart failure has been increasingly recognized and occurs in 30-40% of patients with continuous flow LVADs. This can lead to reduced efficiency of the LVAD and is associated with increased rates of hospitalizations and mortality. Up to 30% of LVAD patients with moderate to severe AI require surgical valve closure or replacement, which is high risk. More recently, case reports demonstrated transcatheter aortic valve replacement (TAVR) is feasible in LVAD patients with symptomatic AI, but there is a lack of large-scale study. Methods: National Readmission Databases (NRD) from 2015 to 2019 were used to identify hospitalizations with International Classification of Diseases-9th Revision and International Classification of Diseases-10th Revision procedural codes for TAVR in patients with and without LVAD. The outcomes of interest were mortality and 30-day readmission rate. Results: We identified a total of 245,176 TAVR hospitalizations. Among them, 146 (0.001%) had LVAD. LVAD patients undergoing TAVR were significantly younger (mean age 67.5 years vs. 79.6 years; P: <0.001) and had more comorbidities such as arrhythmias, peripheral vascular disease, chronic kidney disease, and anemia. On univariate analysis, LVAD patients demonstrated higher mortality (OR 4.88; 95% CI 2.17 - 11.02; P: <0.001), however, multivariate analysis showed this trend to be insignificant (OR 1.91; 95% CI 0.74-4.96; P= 0.184). Overall, patients with LVAD undergoing TAVR did have an increased length of stay and higher cost of hospitalization (P<0.001). We have witnessed the increasing trend of TAVR use in LVAD patients in the last five years (P: 0.009). After the propensity match, the 30-day readmission rate was not statistically significant (26.5 vs. 25%, P: 0.84). Conclusion: In our analysis, the mortality and 30-day readmission of LVAD patients undergoing TAVR were not significantly higher compared to non-LVAD patients. However, this finding may be limited due to the relatively small number of patients. Overall, this study indicates that TAVR may be considered in the appropriately selected LVAD patients.