B-40 | Impact of Congenital Heart Diseases in Adults Undergoing Transcatheter Aortic Valve Replacement: Insight from the National Inpatient Database

Abstract

ACHD patients undergoing TAVR have a higher risk of in-hospital mortality, cardiogenic shock, and use of MCS. Current guidelines do not differentiate TAVR treatment based on ACHD, and more prospective trials could help us identify a suitable approach. We utilized the national inpatient sample (NIS) database using ICD-10 codes to extract all the patients undergoing TAVR between 2016-2019 and stratified them based on the presence or absence of ACHD ( >18 years old). Multivariate logistic regression analysis was used to calculate the adjusted odds (aOR) ratio of in-hospital outcomes. A total of 221,530 patients underwent TAVR, of which 3,640 (1.6%) had ACHD. On adjusted analysis, ACHD patients who underwent the TAVR procedure had a significantly higher risk of in-hospital mortality (aOR 1.84, 95% CI 1.15-2.94), cardiogenic shock (aOR 2.19, 95%CI 1.59-3.02), and cardiac arrest (aOR 2.04, 95% CI 1.10-3.76) with higher use of mechanical circulatory support (MCS) (aOR 1.79, 95% CI 1.06-3.02) than non-ACHD patients. The length of stay (5.57±6.74 vs. 4.06±5.30, p<0.001) and total hospitalization charge ($239,935 vs. $215,195, p<0.0001) were higher in the ACHD group than the non-ACHD group. There was no significant difference in the odds of acute kidney injury (AKI), stroke, acute MI, heart failure, bleeding, and pacemaker implantation between the two groups. ACHD patients undergoing TAVR have a higher risk of in-hospital mortality, cardiogenic shock, and use of MCS. Current guidelines do not differentiate TAVR treatment based on ACHD, and more prospective trials could help us identify a suitable approach.