Predictors of in-hospital early mortality following valve-in-valve transcatheter aortic valve replacement.

Abstract

Background: There is an increasing preference of utilizing valve-in-valve transcatheter aortic valve replacement (ViV TAVR) after bioprosthetic valve failure. However, updated large-scale analysis investigating early-mortality after the patients underwent ViV TAVR is limited.

Objective: This study aimed to assess in-hospital early mortality and analyze the factors associated with in-hospital early mortality among patients who underwent ViV TAVR.

Methods: Using the all-payer, nationally representative National Readmission Database, our study included patients aged 18 years or older who had ViV TAVR between 2017 and 2020. We categorized the cohort into two groups depending on the occurrence of in-hospital early mortality (death within 30 days after the procedure). Based on the ICD-10, we identified the trend of in-hospital early mortality after ViV TAVR and further analyzed the significant factors associated with it.

Results: After adjustment, a total of 11,009 patients who had ViV TAVR were included in this study. 329 (3.0 %) had in-hospital early mortality and 10,680 (97.0 %) without. There was a decreasing trend in in-hospital early mortality from 3.3 % in 2017 to 1.0 % in 2020, but it was insignificant (p = 0.71). In multivariable analysis, the independent factors associated with in-hospital early mortality were chronic liver disease (adjusted odds ratio [aOR]: 3.62; 95 % confidence interval [CI]: 1.96-6.71, p < 0.01), coagulation disorder (aOR: 1.77; CI: 1.16-2.68, p < 0.01) and pulmonary hypertension (aOR: 1.78; CI: 1.18-2.68, p < 0.01). Among patients who died during early readmission following ViV TAVR, the most common cardiac cause and non-cardiac cause of readmission were heart failure (15.4 %) and infection (23.1 %), respectively.

Conclusion: The in-hospital early mortality following ViV TAVR was low at 3.0 %. The independent factors associated with in-hospital early mortality post-procedurally were chronic liver disease, coagulation disorder, and pulmonary hypertension.