Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions Database.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis in high- and intermediate-risk patients, with expanding indications for lower-risk populations. However, post-procedural complications, such as stroke, conduction disturbances, and heart failure readmissions, remain concerns. The aim of our study is to analyze the national trends in TAVR procedures, in-hospital outcomes, major readmission causes, and the association of risk factors for readmissions following TAVR. Methods: We analyzed NIS data (2018-2022) to assess TAVR utilization trends, patient demographics, and in-hospital outcomes. The NRD (2021-2022) was used to evaluate 60-day readmission rates for stroke, complete heart block, and heart failure. Multivariate regression models were employed to identify risk factors having significant association with major readmission causes. Results: TAVR utilization increased from 10,788 cases in 2018 to 17,784 in 2022, with a concurrent decrease in in-hospital mortality (1.33% to 0.90%) and length of stay (3.88 to 2.97 days). Of 123,376 TAVR index admissions in 2021, 28,654 patients had 66,100 readmission events (53.57%) in the 60 days following discharge. Heart failure (17,566 cases, 26.57% of readmissions) was the most common readmission cause, followed by complete heart block (1760 cases, 2.66% of readmissions) and stroke (284 cases, 0.42% of readmissions). Predictors of post-TAVR stroke included uncontrolled hypertension (OR 2.29, p < 0.001) and chronic heart failure (OR 2.73, p < 0.001). Left bundle branch block (LBBB) was strongly associated with complete heart block (OR 12.89, p < 0.001) and heart failure readmissions (OR 7.65, p < 0.001). Conclusions: TAVR utilization has increased with improving perioperative outcomes, but post-TAVR readmissions remain significant, particularly for heart failure, stroke, and conduction disturbances. Pre-procedural uncontrolled hypertension, hyperlipidemia, congestive heart failure, and atrial fibrillation were risk factors with significant association with stroke in the 60 days following TAVR. The presence of documented pre-procedural LBB, RBB, as well as BFB were risk factors with significant association with complete heart block following TAVR placements. Pre-procedural LBB, RBB, BFB, and atrial fibrillation were risk factors having significant association with heart failure readmissions in the 60 days following TAVR.