Abstract 15611: Impact of Amyloidosis in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From National Inpatient Sample 2016- 2019

Abstract

Introduction: Aortic Stenosis (AS) is increasingly recognized as one of the underdiagnosed manifestations of cardiac amyloidosis (CA) and existing literature shows conflicting evidence on the impact of CA on AS. Methods: A retrospective analysis of 2016-2019 NIS was conducted to identify hospitalizations (Age≥18) who underwent TAVR using ICD-10 codes. Existing literature was reviewed to select variables before conducting a univariate screen and balancing between groups with CA vs without CA. Propensity score weights were generated using Doubly robust estimation, and IPTW matching was done. The ATET was calculated by extrapolating propensity weights and using weighted multivariate analysis. Results: Out of 227,200 TAVR, only 245 (1.1%) had a concomitant diagnosis of CA. Hospitalizations with CA had a mean age of 80.49, 71.43% males, 82.98% white, 12.77% black, and others. Analysis total of 3,205 deaths, CA was associated with lower odds of mortality (OR 0.25, p 0.00). Factors associated with increased mortality in TAVR were age, HTN, low household income, elixhauser comorbidity index, mechanical vent >24 hrs, Shock on pressors/device, Pericardial effusion/tamponade, AKI, ESRD on HD, and Acute stroke. Out of 17,590 pacemakers (PPM) implantations, CA was associated with lower odds of getting a PPM (OR 0.13, P 0.00). Factors increasing the risk of getting a PPM were high degree AV block, age, male sex, DM, and ventricular arrhythmias. A total of 4280 acute strokes occurred, and CA was not associated with increased risk following TAVR (OR 0.46, p 0.38). Factors increasing the acute stroke risk after TAVR were age, mechanical vent >24hrs, and anemia. 3460 valve complications occurred, and CA was not associated with increased risk (paravalvular leak, displacement, infection, breakdown, and others) (OR 10.20, p 0.16). A significant risk factor for valve complications after TAVR was the presence of pericardial effusion/tamponade. Conclusions: The presence of CA does not result in poor outcomes in TAVR. Limitations of our study are a small sample, retrospective analysis, and lack of cardiac imaging data. Further studies that eliminate our study's limitations are required to conclusively evaluate the impact of CA in patients who undergo TAVR.