Clinical Outcomes Post-Transcatheter Aortic Valve Replacement in Patients With Hypertrophic Obstructive Cardiomyopathy.

Background: Patients with hypertrophic obstructive cardiomyopathy (HOCM) were excluded from all major trials for transcatheter aortic valve replacement (TAVR). "Suicide left ventricle" occurring after TAVR is postulated to occur as a result of chronic pressure overload from fixed obstruction that is acutely relieved after the valve deployment resulting in worsening left ventricular outflow tract obstruction.

Aims: The aim of this study was to determine the clinical and readmission outcomes in HOCM patients undergoing TAVR.

Methods: Data was extracted from the National Inpatient and National Readmission 2016-2020 Databases. We performed multivariable Logistic regression analysis to determine the odds of in-hospital mortality and other relevant clinical outcomes in patients undergoing TAVR with and without comorbid HOCM. Multivariable Cox regression analysis was used to assess 30-day hospital readmission in HOCM patients undergoing TAVR.

Results: We identified 296,670 patients who underwent TAVR, of whom 534 (0.2%) had comorbid HOCM. The patients undergoing TAVR with comorbid HOCM had more than threefold higher risk of in-hospital mortality (adjusted odds ratio: 3.47, 95% CI 1.37-8.81, p = 0.009) when compared to patients without HOCM. Additionally, patients undergoing TAVR with comorbid HOCM had a higher risk of atrioventricular blocks, cardiogenic shock, acute kidney injury, and the need for intubation. There was no difference in readmission outcomes post-TAVR among patients with and without HOCM.

Conclusion: Our analysis of a large, real-world cohort of patients undergoing TAVR showed that patients with HOCM have a significantly higher risk of in-hospital mortality and procedural complications when compared to patients without HOCM.