Incidence, risk factors and impact of readmission for heart failure after successful transcatheter aortic valve replacement

Abstract

The prevalence and independent correlates of readmission for heart failure (HF) after transcatheter aortic valve replacement (TAVR) remain unclear in all-comers. We sought to evaluate the incidence, risk factors and clinical impact of readmission for HF after successful TAVR in an unselected patient population. All patients undergoing successful TAVR in two high-volume French centers from February 2010 to December 2016 were prospectively included. Cox multivariate model was used to assess risk factors of readmission for HF over one year follow up. A total of 1139 patients aged 82.4 ± 7.7 years were included. Half (52.2%) were male. Transfemoral access and balloon-expandable valve were most frequently used (82.4% and 60.7% respectively). Within one-year of follow-up, 99 (8.7%) patients were readmitted for heart failure. Mortality was increased by two-fold among patients readmitted for HF vs. those without readmission (22 [22.2%] vs. 123 [11.8%], HR 1.9; 95% CI [1.2–3.1], P = 0.004). Chronic pulmonary disease (adjHR 1.8; 95% CI [1.2–2.8], P = 0.008), chronic kidney disease (adjHR 1.7; 95% CI [1.1–2.6], P = 0.01), diabetes mellitus (adjHR 1.7; 95% CI [1.1–2.5], P = 0.01), prior atrial fibrillation (adjHR 1.6; 95% CI [1.1–2.4], P = 0.02) and post-TAVR left ventricular ejection fraction (LVEF) ≤35% (adjHR 2.1 95%CI 1.2–3.7, P = 0.009) independently predicted readmission for HF. Readmission for HF within one year of successful TAVR is frequent and associated with increased mortality. Comorbidities and post-TAVR LVEF ≤35% but not valvular-related factors are the main correlates of readmission for HF.