Impact of heart failure on in-hospital outcomes of pulmonary valve interventions: a nationwide analysis.

BACKGROUND

Data on outcomes of surgical pulmonary valve replacement or repair (SPVR/SPVr) in patients with heart failure (HF) are limited. We aimed to assess the safety and complications of SPVR/SPVr in this population.

METHODS

Adults (≥18 years) who underwent SPVR/SPVr between 2018-2021 were identified from the National Inpatient Sample. Patients were stratified by HF status. In-hospital outcomes included mortality, cardiac arrest, cardiogenic shock, mechanical ventilation (MV), vasopressor use, heart block, permanent pacemaker (PPM), ECMO, bleeding, and acute kidney injury (AKI). Propensity score matching was performed to adjust for comorbidities, hospital factors, income, and elective status. Logistic regression was used to assess associations between HF and outcomes.

RESULTS

There were 4595 SPVR/SPVr; the median age was 35 (26-52). Patients with heart failure had an increased risk of mortality, odds ratio (OR) 3.42 (95% confidence interval [CI] 1.19-6.12); p-value < 0.0001, heart block 1.75 (1.45-2.13); < 0.0001, bleeding 1.31 (1.12-1.52); 0.0005, AKI 1.35 (1.12-1.61); 0.001, vasopressor use 1.33 (1.08-1.65); 0.007, cardiogenic shock 2.34 (1.87-2.93); < 0.0001, MV 1.45 (1.09-1.94); 0.01, in-hospital cardiac arrest 2.29 (1.35-3.91); 0.002, ECMO 2.23 (1.43-3.45); 0.0003. No significant difference in PPM 1.51 (0.85-2.67); 0.1.

CONCLUSION

Heart failure is associated with worse in-hospital outcomes following surgical pulmonic valve replacement or repair. Preoperative optimization and considering earlier surgical intervention may improve outcomes in this high-risk population.