Outcomes of transcatheter aortic valve replacement in heart failure patients: Insights from the National Readmission Database.

BACKGROUND

The effect of ejection fraction on outcomes after transcatheter aortic valve replacement (TAVR) in heart failure (HF) patients remains unclear.

METHODS

Using the National Readmission Database (2016-2020), adult HF patients who underwent TAVR were identified, and outcomes were compared between those with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The primary outcome was all-cause inpatient mortality, while secondary outcomes included major bleeding, packed red blood cell (pRBC) transfusion, acute kidney injury (AKI), ischemic cerebrovascular accidents (CVA), valvular complications, conversion to open surgery, length of stay, and total charges.

RESULTS

Among 231,092 HF patients who underwent TAVR, 89,782 had HFrEF. Compared to HFpEF patients, HFrEF was associated with higher inpatient mortality (adjusted odds ratio [aOR] 1.97, 95 % CI 1.78-2.19, P < 0.001), major bleeding (aOR 1.49, 95 % CI 1.36-1.63, P < 0.001), pRBC transfusion (aOR 1.28, 95 % CI 1.19-1.38, P < 0.001), AKI (aOR 1.89, 95 % CI 1.79-1.99, P < 0.001), valvular complications (aOR 1.41, 95 % CI 1.21-1.64, P < 0.001), and conversion to open surgery (aOR 1.72, 95 % CI 1.28-2.34, P < 0.001), with no significant difference in ischemic CVA (aOR 1.12, 95 % CI 0.97-1.29, P = 0.13). HFrEF was also associated with longer hospital stays (adjusted mean difference [aMD] 2.06 days, 95 % CI 1.93-2.18, P < 0.001) and higher total charges (aMD $29,783, 95 % CI 25,106-34,460, P < 0.001).

CONCLUSION

Patients with HFrEF undergoing TAVR experienced worse outcomes compared to those with HFpEF. These findings underscore the need for meticulous patient selection and risk evaluation before performing TAVR in HF patients.