Abstract 9200: In-Hospital Outcomes and Readmission Rates of Transcatheter Aortic Valve Replacement in Mixed Aortic Valve Disease

Abstract

Introduction: Transcatheter Aortic Valve Replacement (TAVR) is indicated in patients with severe aortic stenosis (AS) and is increasingly performed in patients with combined AS and aortic regurgitation. We evaluated in-hospital outcomes and readmission rates after TAVR in patients with mixed aortic valve disease (MAVD). Methods: A total of 100,573 TAVR procedures were identified between 2011-2017 using ICD-9 and -10 codes from the Nationwide Readmissions Database (NRD). We separated patients into two cohorts, those with MAVD and those with pure AS. Primary outcome was post-TAVR all-cause inpatient mortality; secondary outcomes included rates of 30- and 90-day readmissions, paravalvular leak (PVL), permanent pacemaker (PPM) insertion, acute kidney injury, major bleeding, postoperative ischemic stroke, total cost of hospitalization and length of hospital stay. Results: A total of 3,260 patients had MAVD (median age 83 years, 43.5% women). In-hospital mortality (2.5% vs 2.6%, p=0.531), rates of PVL (1.0% vs 1.3%, p=0.056) and hospital length of stay (5.8±7.8 vs. 6.7±7.8, p=0.126) were similar between the MAVD and pure AS groups. 30- (0.5% vs. 8.8%, p<0.001) and 90-day readmission rates (0.8% vs. 16.0%, p<0.001), major bleeding (7.4% vs. 9.6%, p<0.001), acute kidney injury (12.9% vs. 15.1%, p<0.001), postoperative ischemic stroke (2.0% vs. 5.7%, p<0.001) and mechanical circulatory support use (1.9% vs. 4.5%, p<0.001) were less prevalent in the MAVD cohort. Using logistic regression, MAVD was not predictive of mortality in patients undergoing TAVR (adjOR: 1.25, 95% CI; 0.99 to 1.57, p=0.056), however MAVD was associated with: decreased odds of 30- (adjOR: 0.05, 95% CI; 0.03 to 0.08, p<0.001) and 90-day readmission rates (adjOR: 0.04, 95% CI; 0.03 to 0.06, p<0.001), and higher odds of PPM implantation (adjOR: 1.46, 95% CI; 1.29 to 1.65, p<0.001). Conclusion: Despite differences in the aortic valve and left ventricular anatomy (pressure versus volume related adaptive changes) in patients with MAVD and pure AS, TAVR appears safe and feasible. However, patients with MAVD were more likely to have permanent pacemakers implanted. The results of our study warrant further randomized controlled studies to confirm these findings.