Clinical Outcomes Post-Transcatheter Aortic Valve Replacement in Patients With Hypertrophic Obstructive Cardiomyopathy.

BACKGROUND

Patients with hypertrophic obstructive cardiomyopathy (HOCM) were excluded from all major trials for transcatheter aortic valve replacement (TAVR). "Suicide left ventricle" occurring after TAVR is postulated to occur as a result of chronic pressure overload from fixed obstruction that is acutely relieved after the valve deployment resulting in worsening left ventricular outflow tract obstruction.

AIMS: The aim of this study was to determine the clinical and readmission outcomes in HOCM patients undergoing TAVR.

METHODS

Data was extracted from the National Inpatient and National Readmission 2016-2020 Databases. We performed multivariable Logistic regression analysis to determine the odds of in-hospital mortality and other relevant clinical outcomes in patients undergoing TAVR with and without comorbid HOCM. Multivariable Cox regression analysis was used to assess 30-day hospital readmission in HOCM patients undergoing TAVR.

RESULTS

We identified 296,670 patients who underwent TAVR, of whom 534 (0.2%) had comorbid HOCM. The patients undergoing TAVR with comorbid HOCM had more than threefold higher risk of in-hospital mortality (adjusted odds ratio: 3.47, 95% CI 1.37-8.81, p = 0.009) when compared to patients without HOCM. Additionally, patients undergoing TAVR with comorbid HOCM had a higher risk of atrioventricular blocks, cardiogenic shock, acute kidney injury, and the need for intubation. There was no difference in readmission outcomes post-TAVR among patients with and without HOCM.

CONCLUSION

Our analysis of a large, real-world cohort of patients undergoing TAVR showed that patients with HOCM have a significantly higher risk of in-hospital mortality and procedural complications when compared to patients without HOCM.