TAVR Procedures Research Articles

National Costs for Cardiovascular-Related Hospitalizations and Inpatient Procedures in the United States, 2016 to 2021

The current economic burden of cardiovascular-related hospitalizations grouped by diagnoses and procedures in the U.S. has not been well characterized. The objective was to identify current trends in cardiovascular-related hospitalizations, procedural utilization, and health care costs, using the most recent 6 years of hospitalization data. A retrospective analysis of discharge data from the National Inpatient Sample (NIS) database was conducted to determine trends in cardiovascular-related hospitalizations, costs, and procedures for each year from 2016 to the most recent available dataset, 2021. Total cardiovascular-related costs were adjusted to and reported in 2023 dollars. In 2021, there were 4,687,370 cardiovascular-related hospitalizations at a cost of $108 billion. Heart failure hospitalizations accounted for the highest costs at $18.5 billion, followed by Non-ST-Elevation Myocardial Infarction at $11.2 billion, and stroke at $10.9 billion. Significant upward trends in costs from 2016 to 2021 were observed for heart failure, stroke, atrial fibrillation, ST-elevation myocardial infarction, chest pain, hypertensive emergency, ventricular tachycardia, aortic dissection, sudden cardiac death, pericarditis, supraventricular tachycardia, and pulmonary heart disease. Over the 6 observational years, total costs increased by over $10 billion, representing a 10 percent increase. However, the increases were not linear, as there was a significant increase of 6.5% from 2018 to 2019, then a dip of over 7% from 2019 to 2020, followed by a rise of about 6% from 2020 to 2021. By 2030, total CV-related costs are projected to reach $131.3 billion. For all years, coronary procedures were the most performed, followed by ECMO, non-bypass peripheral vascular surgery, pacemaker placement, and CABG. Both TAVR and MitraClip procedures demonstrated significant upward trends from 2016 to 2021. Overall, from the years 2016 to 2021, cardiovascular-related hospitalizations, costs, and procedures demonstrated upward trends. In conclusion, cardiovascular disease remains a high burden in the hospital setting with tremendous health care costs.

Thrombotic Thrombocytopenia Purpura (TTP) following emergent aortic valve replacement after a complicated TAVR procedure: a case report and review of the literature

BackgroundThrombotic thrombocytopenic purpura (TTP) is a rare hematological disorder. The occurrence of TTP subsequent to an emergent aortic valve replacement after a TAVR procedure is exceedingly uncommon with only a few reported cases worldwide.Case PresentationWe report the case of a 70-year-old female patient diagnosed with aortic insufficiency. Following a transcatheter aortic valve replacement, she underwent emergency aortic valve replacement under cardiopulmonary bypass on the subsequent day due to heart valve displacement. The postoperative diagnosis revealed TTP and symptomatic treatment involving plasma exchange was administered. After demonstrating steady improvement, the patient was eventually discharged.ConclusionAortic valve replacement after TAVR is a high-risk procedure and increases susceptibility for developing secondary TTP. The diagnosis and treatment of secondary TPP is considerably challenging, and early diagnosis with symptomatic treatment including plasma exchange can increase patient survival.

CASE REPORT: SELF–EXPANDING TRANSCATHETER VALVE IMPLANTATION (ACURATE NEO 2) IN A VERY SMALL NATIVE AORTIC ANNULUS

Abstract We present the case of a 74–year–old female, symptomatic for dyspnea on exertion, evaluated by our Cardiac Team for severe aortic valve (AV) stenosis. The transesophageal echocardiography showed a stenotic tricuspid AV (valve area of 0.51 cm2, peak and mean gradients of 75 mmHg and 43 mmHg respectively), normal left ventricle (LV) ejection fraction without significant intraventricular gradient. Pre–operative thoraco–abdominal computed tomography angiography showed an AV without significant calcifications, an aortic annulus perimeter of 51.7 mm (area of 207,8 mm2) and a left ventricular outflow tract (LVOT) perimeter of 45.3 mm with elliptical shape (area of 149,9 mm2). The TAVR procedure was performed with an ‘off–label’ implantation of a SE THV with supra–annular location of leaflets (Acurate Neo 2 23 mm), without any predilation. The post–procedural transthoracic echocardiographic study highlighted the correct positioning of the bioprosthesis without significant protrusion in the LVOT and without any interference with the mitral valve apparatus. The main clinical, technical and procedural considerations have been: According to recommendations, the minimum perimeter of 56.5 mm and the minimum area of 254 mm2 represent the lower limits of the sizing guidelines for THV currently available. We used a SE valve with supra–annular location of the leaflets that offers a potential advantage over BE valves and intra annular SE valves, ensuring a larger effective orifice area. We avoided pre– and post–dilatation to reduce the risk of annular damage and/or rupture The precision of THV implantation (with minimal protrusion in LVOT) was maximized when the rapid pacing during phase 2 of the valve deployment was utilized. A short period of DAPT can be considered in order to prevent a potential increase of thromboembolic events secondary to small aortic valve area. In our opinion the main goal is to prevent high implantation and commissural misalignment in order to facilitate the subsequent coronary percutaneous interventions if needed. Even prophylactic coronary stenting (‘chimney fashion‘) should be avoided unless absolutely necessary. These technical considerations applies also to allow a subsequent valve–in–valve (VIV) procedure, if indicated. To our knowledge, this is among the smallest native aortic annulus so far described and treated percutaneously in a tricuspid stenotic aortic valve with a self–expanding (SE) THV Acurate Neo 2.

PERCUTANEOUS TREATMENT OF ABDOMINAL AORTIC ANEURYSM AND AORTIC VALVE STENOSIS WITH ‘STAGED’ EVAR & TAVR

Abstract Symptomatic AS and AAA are critical clinical conditions, increasingly more prevalent with aging of the population. TAVR is a treatment of choice in high risk and inoperable patients with symptomatic severe AS, who are often elderly. A continuous increase in the number of TAVR procedures–per–year is expected due to the increasingly robust evidence that TAVR is advantageous in the population with non–increased surgical risk. Our ‘tailored’ interventional approach has planned an endovascular correction of the AAA as the first step, followed by a ‘staged’ TAVR. The AAA was treated first because was it considered strategically better in the presence of severe AS in stable clinical conditions. Moreover the potential elevation of the systolic arterial pressure after TAVR might provoke enhanced strain at the AAA wall increasing the risk of rupture. During the EVAR procedure all the material needed to proceed to an ‘urgent’ aortic valvuloplasty or TAVR if necessary was available and ready. The proposed treatment was effective in all treated patients, offering the resolution of both problems through totally percutaneous treatment in patients with a significant high risk for both mortality and vascular complications. The risk of acute kidney injury is reduced compared to simultaneous procedures because the total amount of contrast agents used overall is spread among two different procedures after an adequate time of recovery. The main clinical, technical and procedural considerations of TAVR procedure in this case series were: Transfemoral access into the bifurcated endoprosthesis was feasible in 100% of patients The use of highly supportive stiffer guides (or buddy wire technique) to overcome the tortuosity of the iliac–femoral approaches should be considered; The introducer advancement under fluoroscopic guidance and through–and–through wire technique is strongly recommended in the presence of tortuosity; The strategy to protect the main vascular access must be personalized choosing between the ipsilateral femoral approach or the radial (or omeral) approach; The total amount of contrast medium administered to patients should be carefully monitored; The procedures should always be conducted with as much ‘contrast zero‘ methods as possible. Define a delay time between EVAR and TAVR according to the clinical status, the age and the co–morbidities of patients even in the presence of clinical stability, is highly debated.

Carbon Footprint of Total Intravenous and Inhalation Anesthesia in the Transcatheter Aortic Valve Replacement Procedure

ObjectiveWe aimed to quantify and compare the emissions for deep sedation with TIVA and general anesthesia with inhaled agents during the transcatheter aortic valve replacement procedure. Designa retrospective study. Settingat a tertiary hospital in Boston. ParticipantsThe anesthesia records of 604 consecutive patients who underwent the TAVR procedure between January 1, 2018 and March 31, 2022 were reviewed and analyzed. InterventionsData were examined and compared in the following two groups: general anesthesia with inhaled agents and deep sedation with TIVA. Measurements & Main ResultsThe gases, drugs, airway management devices, and anesthesia machine electricity were collected and converted into CO2e. The carbon emissions of intravenous medications were converted with the CO2e data for anesthetic pharmaceuticals from Parvatker et al. study. For inhaled agents, inhaled anesthetics and oxygen/air flow rate were collected at 15-minute intervals and calculated using the anesthetic gases calculator provided by the Association of Anesthetists. The airway management devices were converted based on life-cycle assessments. The electricity consumed by the anesthesia machine during general anesthesia was estimated from the manufacturer's data (Drager, GE, USA) and local Energy Information Administration data. The data were analyzed in the Chi-squared test or Wilcoxon rank-sum test. There were no significant differences in the patient's demographic characteristics, such as age, gender, weight, height, and BMI. The patients who received general anesthesia with inhaled agents had statistically higher total CO2e per case than deep sedation with TIVA (16.188 vs. 1.518 kg CO2e, P < 0.001), primarily due to the inhaled agents and secondarily to airway management devices. For deep sedation with TIVA, the major contributors were intravenous medications (71.02%) and airway management devices (16.58%). A subgroup study of patients who received sevoflurane only showed the same trend with less variation. ConclusionsWe found that the patients who received volatile anesthesia had a higher CO2e per case. This difference remained after a subgroup analysis evaluating those patients only receiving sevoflurane and after accounting for the differences in the duration of anesthesia. Data from this study and others should be collectively considered as a health care profession aims to provide the best care possible for our patients while limiting the harm we cause to the environment.

Impact of the coronavirus disease 2019 pandemic on aortic valve replacement and outcomes in France

BackgroundThe coronavirus disease of 2019 (COVID-19) pandemic lockdowns limited access to medical care. The impact on surgical (SAVR) and transcatheter (TAVR) aortic valve replacement (AVR) has been poorly described. AimWe sought to evaluate the impact of the COVID-19 pandemic on the number and modalities of AVR, patient demographics and in-hospital outcomes at the nationwide level. MethodsUsing the French nationwide administrative hospital discharge database, we compared projected numbers and proportions of AVR and hospital outcomes, obtained using linear regressions derived from 2015–2019 trends, with those observed in 2020. ResultsIn 2020, 21,382 AVRs were performed (13,051 TAVRs, 5706 isolated SAVRs and 2625 SAVRs combined with other cardiac surgery). Compared with the 2020 projected number of AVRs (24,586, 95% confidence interval [CI] 23,525–25,646), TAVRs (14,866, 95% CI 14,164–15,568), isolated SAVRs (6652, 95% CI 6203–7100) and SAVRs combined with other cardiac surgery (3069, 95% CI 2822–3315), there were reductions of 13.0%, 12.2%, 14.2% and 14.5%, respectively. These trends were similar regardless of sex or age. In 2020, the mean age, Charlson Comorbidity Index and hospital admission duration continued to decline, and the proportion of females remained constant, following 2015–2019 trends. Overall, 2020 in-hospital mortality was higher than projected (2.0% observed vs. 1.7% projected; 95% CI 1.5–1.9%), with no increased pacemaker implantation, but more acute kidney injury and cerebrovascular accidents in some surgical subsets. ConclusionsDuring the COVID-19 pandemic, fewer TAVR and SAVR procedures were performed, with increased in-hospital mortality and periprocedural complications. Extended follow-up will be important to establish the long-term effect of the COVID-19 pandemic on patient management and outcomes.

Is electrophysiological study a novel predictor for permanent pacemaker implantation after transcatheter aortic valve implantation?

Despite advancements in valve technology and increased clinical experience, complications related to conduction defects after transcatheter aortic valve implantation (TAVR) have not improved as rapidly as expected. In this study, we aimed to predict the development of complete atrioventricular (AV) block and bundle branch block during and after the TAVR procedure and to investigate any changes in the cardiac conduction system before and after the procedure using electrophysiological study. A total of 30 patients who were scheduled for TAVR at our cardiovascular council were planned to be included in the study. TAVR was performed on patients at Erciyes University Medical Faculty Hospital as a single center between May 2019 and August 2020 Diagnostic electrophysiological study was performed before the TAVR procedure and after its completion. Changes in the cardiac conduction system during the preprocedure, intra-procedure, and postprocedure periods were recorded. Significant increases in baseline cycle length, atrial-His (AH) interval, his-ventricular (HV) interval and atrioventricular (AV) distance were observed before and after the TAVR procedure (p = 0.039, p < 0.001, p = 0.018, p < 0.001, respectively). During the TAVR procedure, the preprocedural HV interval was longer in patients who developed AV block and bundle branch block compared to those who did not and this difference was statistically significant (p = 0.024). ROC curve analysis revealed that a TAVR preprocedure HV value >59.5 ms had 86% specificity and 75% sensitivity in detecting AV block and bundle branch block (AUC = 0.83, 95% CI: 0.664-0.996, p = 0.013). The preprocedure HV distance was 98 ± 10.55ms in the group with permanent pacemaker implantation and the mean value in the group without permanent pacemaker implantation was 66.27 ± 15.55 ms, showing a borderline significant difference (p = 0.049). The prolongation of HV interval in patients with AV block and bundle branch block suggests that the block predominantly occurs at the infra-hisian level. Patients with longer preprocedural HV intervals should be closely monitored for the need for permanent pacemaker implantation after the TAVR procedure.

Safety and efficacy of protamine administration for prevention of bleeding complications in patients with recent PCI undergoing TAVR

Abstract Background Despite major advances, TAVR is still associated with vascular and bleeding complications, that have an impact on mortality. Recent studies have shown that heparin antagonization using protamine resulted in lower bleeding rates in patients undergoing TAVR as compared to those without heparin reversal. However, there are only limited data on the safety of protamine regarding thromboembolic complications including in-stent thrombosis in TAVR patients who have had a recent PCI. Accordingly, daily practice varies between Centers. Purpose The aim of this multicentre study was to evaluate the safety and efficacy of protamine administration in patients who have had a recent PCI undergoing subsequent TAVR. Methods Our study included 1838 patients undergoing TAVI between 2017 and 2020. Of the patients included, 173 (9.4%) had a recent PCI (≤30 days), 319 (17.4%) had an intermediately (≥30 days) and 303 (16.5%) a previously performed PCI (≥6 months). Standardized vascular access management included the use of preclosure devices and PTA or implantation of a stent-graft, if necessary. The primary endpoint was a composite of one-year mortality and myocardial infarction at 30 days. Secondary endpoints included 30-day mortality and VARC-3-defined complications. Results The overall study population had a mean age of 81.1±6.2 years. Among patients with recent PCI, 134 (77.5%) patients received protamine for heparin reversal during the TAVR procedure. In the group of patients with intermediately and previously performed PCI 258 (80.9%) and 249 (82.2%) patients received protamine, respectively. In the recent PCI group, the occurrence of the primary endpoint was comparable between patients with protamine administration (24.6%) as compared to patients without heparin reversal (30.8%, p=0.53, Figure 1). Similarly, among patients with intermediately as well as previously performed PCI, the rates of the primary endpoint were comparable irrespective of protamine administration (20.1 vs 16.4%, p=0.59; 17.3 vs 27.7%, p=0.08, respectively, Figure 2). Moreover, among all three groups, the incidence of myocardial infarction at 30 days after TAVR was low and comparable between patients with and without heparin reversal (p&amp;gt;0.50). Overall, protamine administration was associated with decreased life-threatening bleeding (3.2 vs 9.4%, p&amp;lt;0.01) and major vascular complications (4.4 vs 7.9%, p=.02). Regarding safety endpoints, no overall differences were observed in the incidence of stroke between patients with and without protamine administration (1.5 vs 2.9%, p=0.13). Conclusion Protamine administration during the TAVR procedure did not increase the rate of myocardial infarction or one-year mortality in patients who have had a recently or intermediately performed PCI. Overall, heparin reversal using protamine resulted in significantly lower rates of life-threatening bleeding and major vascular complications, without increasing the incidence of stroke.Figure 1Figure 2

Abstract 16653: Assessment of Price Variation for TAVR and SAVR Procedures Across US Hospitals

Introduction Transcatheter Aortic Valve Replacement (TAVR) has become a mainstay of aortic stenosis treatment, alongside Surgical Aortic Valve Replacement (SAVR). Despite their widespread use, little is known about their commercial cost burden as this data was confidential prior to the 2021 Federal Price Transparency Final Rule. Using newly available pricing data, we aimed to compare hospital variation in TAVR and SAVR prices and describe factors predictive of prices. Methods Prices for DRG 267 (TAVR) and 220 (SAVR) were extracted from the Turquoise Health database and linked to hospital characteristics using Medicare IDs. Price variation within and across hospitals was assessed by calculating the ratio between the 90th and 10th percentile commercial or hospital rates, respectively. The Kruskal-Wallis test was used to test for associations between price and categorical factors. Results 1116 hospitals reported prices for TAVR and 1215 hospitals reported prices for SAVR. Commercial prices for TAVR ($70,482) and SAVR ($66,629) were 1.83 and 1.77x the Medicare price. Within hospitals, the 90th percentile payer-negotiated TAVR price was 1.80x the 10th percentile price, while across hospitals, the 90th percentile hospital by median commercial price was 3.40x the 10th percentile price. This was similar for SAVR. Several factors were associated with higher prices, including major teaching status (TAVR $17,736 and SAVR $19,057 vs non-teaching). For-profit status and investor-ownership were associated with lower prices. While higher hospital-wide readmission rates and higher hospital ratings were associated with higher prices, there was no significant association with hospital-wide mortality. Conclusion This analysis demonstrates substantial markups for TAVR and SAVR commercial prices and significant variation both within and between hospitals associated with teaching status, hospital ratings, and readmissions but not hospital mortality.

Results of streamlining TAVR procedure towards a minimalist approach: a single center experience in Taiwan

Trans-femoral transcatheter aortic valve replacement (TF-TAVR) performed under conscious sedation (LACS) is not yet become routine practice in Taiwan. We aimed to compared the results between patients received general anesthesia (GA) versus LACS. Our cohort was divided into 3 groups: initial 48 patients received TF-TAVR under routine GA (GA group), subsequent 50 patients under routine LACS (LACS group 1), and recent 125 patients under LACS (LACS group 2). The baseline, procedural characteristics and all outcomes were prospectively collected and retrospectively compared. From Sep 2010 to July 2019, a total of 223 patients were included. The procedure time (157.6 ± 39.4 min vs 131.6 ± 30.3 vs 95.2 ± 40.0, < 0.0001), contrast medium consumption (245.6 ± 92.6 ml vs 207.8 ± 77.9 vs 175.1 ± 64.6, < 0.0001), length of intensive care unit (2 [1–5] days vs 2 [1–3] vs 1 [1–1], P = 0.0001) and hospital stay (9 [7–13] days vs 8 [6–11] vs 6 [5–9], P = 0.0001) decreased significantly with LACS, combined with a trend of less hospital acquired pneumonia (12.5% vs 6.0% vs 5.6%, P = 0.427). 1-year survival rate were also different among 3 groups (83.3% vs 90.0% vs 93.6%, P = 0.053). In our single center experience, a “minimalist” approach of TF-TAVR procedure resulted in less medical resources usage, along with more favorable clinical outcomes.

Multimodality Imaging in Planning of Complex TAVR Procedures

Multimodality Imaging in Planning of Complex TAVR Procedures

Single center experience with the balloon-expandable Myval transcatheter aortic valve system with the first 100 patients: 30-day and 1-year follow-up.

To report our single-center data, regarding the first 100 patients who underwent TAVR procedure with the new balloon-expandable MYVAL system. We report 30-day and 1-year outcomes in low to high-risk TAVR patient population. From November 2019 to July 2021, 100 consecutive patients underwent TAVR procedure. Patient outcome was classified according to the VARC-2 definitions. The device performance was assessed using transthoracic echocardiography. Data collection was allowed by the Local Ethical Committee. The mean age was 74.7 years, 63 (63%) were male. The mean Euroscore II and STS score were 4.8 ± 4.9 and 5.6 ± 3.9, respectively. Transfemoral access was the most frequent (surgical vs. percutaneous 2% vs. 97%) and in one patient surgical subclavian access was used. VARC-2 outcomes were as follows: device success 99%, STROKE 1%, major and minor vascular complication was 1% and 11%, respectively, the rate of new permanent pacemaker implantation was 30.7%. At discharge, the incidence of grade I, grade II aortic regurgitation was 39% and 1%, respectively, without relevant PVL. In-hospital mortality was only 1%. These results included a high proportion (17%) of patients with bicuspid aortic valves. At 1 year, the all-cause mortality rate was 7% (only two due to cardiac event) and only a single patient had valve-related dysfunction requiring surgical aortic replacement. TAVR procedure with MYVAL transcatheter heart valve system shows excellent 30-day and 1-year outcomes regarding patient survival, technical success, and valve-related adverse events. The limitations of our study comprise a single-center study with retrospective data collection.

TCT-719 Intravascular Lithotripsy in Peripheral Lesions With Severe Calcification and its Role in TAVR Procedure: A Multicenter Systematic Review and Meta-Analysis

TCT-719 Intravascular Lithotripsy in Peripheral Lesions With Severe Calcification and its Role in TAVR Procedure: A Multicenter Systematic Review and Meta-Analysis

Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: Apropensity-matched analysis.

The Transcatheter Valve Therapy Registry was queried for TAVR procedures using transaxillary and transcarotid access between July 2015 and June 2021. Patients received a self-expanding Evolut R, PRO, or PRO+valve (Medtronic) and had 1-year follow-up. Thirty-day and 1-year outcomes were compared in transcarotid and transaxillary groups after 1:2 propensity score-matching. Multivariable regression models were fitted to identify predictors of key end points. The propensity score-matched cohort included 576 patients receiving transcarotid and 1142 receiving transaxillary access. Median procedure time (99 vs 118 minutes; P<.001) and hospital stay (2 vs 3days; P<.001) were shorter with transcarotid versus transaxillary access. At 30days, patients with transcarotid access had similar mortality (Kaplan-Meier estimates 3.7% vs 4.3%, P=.57) but significantly lower stroke (3.1% vs 5.9%; P=.017) and mortality or stroke (6.0% vs 8.9%; P=.033) compared with patients receiving transaxillary access. Similar differences were observed at 1year. Transaxillary access was associated with increased risk of 30-day stroke (hazard ratio, 2.14; 95% confidence interval, 1.27-3.58) by multivariable regression analysis. Transcarotid versus transaxillary access for TAVR using a self-expanding valve is associated with procedural benefits and significantly lower stroke and mortality or stroke at 30days. In patients with unsuitable femoral anatomy, transcarotid access may be the preferred delivery route for self-expanding valves.

Chronic Limb-Threatening Ischemia Is Associated With Higher Mortality and Limb Revascularization After Transcatheter Aortic Valve Replacement

Peripheral arterial disease (PAD) is common in patients with symptomatic aortic stenosis. PAD exists as a spectrum, and patients with chronic limb-threatening ischemia (CLTI), the most severe form of PAD, are at high risk for limb loss and death. We seek to determine patient characteristics and clinical outcomes among patients who underwent TAVR with or without CLTI. We identified all hospitalizations for TAVR from October 2015 to December 2018 using the National Inpatient Sample database. Patients with any diagnosis of CLTI were identified using the International Classification of Diseases 10th Revision codes. The primary outcome was in-hospital mortality, and secondary outcomes were major complications, open revascularization, and endovascular revascularization after TAVR. During the study period, a total of 31,335 hospitalizations for TAVR procedures were included, including 7,048 (22.5%) in patients with CLTI. CLTI was associated with higher in-hospital mortality (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.13 to 1.74, p=0.002) and major complications (OR 1.2, 95% CI 1.09 to 1.25, p <0.001). CLTI was also associated with a significantly higher rate of open limb revascularization (OR 5.1, 95% CI 3.94 to 6.48, p <0.001) and endovascular revascularization (OR 4.0, 95% CI 3.54 to 4.59, p <0.001). CLTI among patients who underwent TAVR is associated with higher in-hospital mortality, major complications, and longer lengths of stay compared with patients without CLTI. However, the overall rates of adverse events remain low. Further studies are needed to optimize the multidisciplinary care of these patients before TAVR with a focus on shared decision-making.

Transcatheter Aortic Valve Replacement in Patients With Pure Native Aortic Regurgitation: Results From a Multicenter Registry Study

Objective: Patients with untreated severe aortic regurgitation (AR) have a high risk of mortality. Transfemoral transcatheter aortic valve replacement (TF-TAVR) is a treatment option for AR; however, the safety and efficacy of this technique have not been sufficiently established. This study aimed to evaluate the clinical and anatomical variables correlating with device success of TF-TAVR using a self-expanding valve system for pure AR. Methods: Patients with pure native severe AR who underwent TF-TAVR using a self-expanding valve system were registered at 5 Chinese centers. The primary endpoint was device success at 1 month after TAVR. The secondary endpoint was the composite of major adverse cardiovascular events (MACE) at 6 months, including all-cause death, ischemic stroke, emergency conversion to cardiac surgery, and permanent pacemaker implantation. Echocardiography was used to analyze the left ventricular function before the TAVR procedure and during follow-up. Multivariable logistic regression and Cox regression analyses were performed to find relevant independent risk factors. Results: Between September 2019 and February 2022, 79 patients with AR were enrolled in the study. At 1 month, device success was achieved in 60 (75.9%) patients. By 6 months, 29 (36.7%) patients had MACE. Echocardiography revealed improved left ventricular function after TAVR. Multivariate regression analysis demonstrated that the Society of Thoracic Surgeons risk score (odds ratio 0.760, 95% confidence interval (CI): 0.584–0.989; P = 0.041) and annulus perimeter (odds ratio 0.888, 95% CI: 0.796–0.992; P = 0.035) were 2 predictors of device success. Moreover, annulus perimeter (&lt;80.2 mm), but not Society of Thoracic Surgeons risk score, was associated with a significant reduction in MACE at 6 months (hazard ratio 2.223, 95% CI: 1.060–4.659; P = 0.028). Conclusions: TF-TAVR using a self-expanding valve system appears to be a safe and feasible treatment for patients with pure native severe AR, particularly those with a less enlarged annulus.

MT39 Incremental Costs of New Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement (TAVR)

Post-Transcatheter Aortic Valve Replacement (TAVR) complications requiring a new permanent pacemaker implantation (PPMI) have been associated with increased mortality and rehospitalization; however, there is a lack of contemporary evidence on the direct and indirect costs associated with PPMI post-TAVR, and this has meaningful implications for the economics of TAVR procedures. The objective of this study was to determine contemporary estimates of costs and resource utilization associated with post-TAVR PPMI.

Underutilization of Transcatheter Aortic Valve Replacement in Northern Plains American Indians with Severe Aortic Stenosis

IntroductionTranscatheter aortic valve replacement (TAVR) has overtaken surgical aortic valve replacement and revolutionized the treatment strategy for aortic valve replacement. Little is known on the disparities among minorities, especially American Indians (AI), undergoing this procedure. We explore TAVR outcomes to identify disparities at our institution.MethodsRetrospective chart review was completed on patients who underwent TAVR at a North Dakota community hospital between 2012 and 2021. There were 1133 non-AI and 20 AI patients identified (n = 1153). AI patients were identified by enrollment in nationally recognized tribes, Indian Health Service (IHS), or who self-identified as AI. Patient demographics, preoperative characteristics, procedural information, and outcomes were collected. United States 2020 census data was used for state-wide population racial percentages. Unpaired two tail t test assuming unequal variance and chi-squared tests were used to evaluate data and identify disparities between AI and non-AI.ResultsAI presented at an earlier age (71 vs. 79; p = .001) with higher rates of diabetes (60% vs. 35%; p = .018) and history of smoking (100% vs. 60%; p ≤ .001) than Caucasian/white (C/W). The Society of Thoracic Surgery (STS) risk scores (3.2% vs. 4.6%; p = .054) and aortic valve mean gradients were lower among AI (42.8 mmHg vs. 47.5 mmHg; p = .010). For those deceased, AI had significantly shorter lifespans post-TAVR compared to C/W (374 days vs. 755 days; p = .004). AI from North Dakota had fewer TAVR procedures performed than expected (4 actual vs. 32 expected; p < .001).ConclusionsAI undergoing TAVR presented earlier, with higher rates of diabetes and smoking, lower STS risk scores, and lesser aortic valve gradients than C/W. The number of TAVR procedures performed on AI from North Dakota was lower than anticipated despite a nearly 10-year period and the disparities experienced by AI who could have otherwise benefited from TAVR.

Recurrent Valve Migration During TAVR: Using One Valve to Anchor Another Valve.

This case describes management of recurrent valve migration during a TAVR procedure in a patient with a hypertrophic and hyperdynamic left ventricle. Since anchoring a valve in an optimal position within the aortic annulus was not possible, a valve was intentionally deployed deep within the left ventricular outflow tract. This valve was used as an anchoring site for an additional valve, which achieved an optimal hemodynamic result and clinical outcome outcome.

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

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.