Association of hematological malignancies with clinical and financial outcomes following transcatheter aortic valve replacement.

BACKGROUND

While Transcatheter Aortic Valve Replacement (TAVR) is increasingly performed in patients with severe aortic stenosis, the impact of Hematologic Malignancies (HM) on associated outcomes, remains unclear. The authors The authors used a contemporary national database to investigate whether HM is associated with adverse clinical and financial outcomes following elective TAVR.

MATERIALS AND

METHODS

The authors The authors identified all adult (≥ 18-years) hospitalizations for elective TAVR in the 2016-2021 Nationwide Readmissions Database. Multivariable models were constructed to evaluate the association of HM with in-hospital mortality, major complications, non-home discharge, Length of Stay (LOS), index hospitalization costs, and 30-/90-day non-elective readmissions.

RESULTS

Of an estimated 336,998 TAVR procedures, 6123 (1.8 %) involved patients with HM. After risk adjustment, HM was not linked to in-hospital mortality (AOR = 0.96; 95 % CI 0.65-1.40; p = 0.82) or major complications, but conferred a modestly prolonged LOS (β+0.12 days; 95 % CI 0.01-0.25; p = 0.04) and increased costs (β+$1300; 95 % CI $400-$2300; p = 0.01). Moreover, HM was associated with higher odds of 30-day (AOR = 1.27; 95 % CI 1.13-1.42; p < 0.001) and 90-day (AOR = 1.33; 95 % CI 1.20-1.48; p < 0.001) non-elective readmissions. Notably, among 217 HM patients with a history of stem cell transplantation, in-hospital mortality risk was substantially elevated (AOR = 7.7; 95 % CI 1.53-38.8; p = 0.01).

CONCLUSION

In conclusion, although HM did not adversely impact in-hospital mortality or major complications following TAVR, it was linked to modestly increased resource utilization and readmission. Patients with prior stem cell transplantation represent a particularly vulnerable subgroup, underscoring the need for multidisciplinary pre-operative evaluation and specialized perioperative care pathways.