Incidence, Predictors, and Outcomes of Major Transcatheter Aortic Valve Replacement (TAVR) Complications and Failure-to-Rescue in the Contemporary Era

TL;DR

This study analyzes major complications after TAVR procedures, finding that they are rare but linked to high mortality and increased hospital costs.

Contribution

The study identifies contemporary predictors and outcomes of major TAVR complications using a large national database.

Findings

Major TAVR complications occurred in 1.2% of cases and were associated with 26% in-hospital mortality.

Predictors of complications included younger age, bicuspid aortic valve, thoracic aneurysm, and female sex.

Complications led to longer hospital stays and significantly higher costs compared to uncomplicated cases.

Abstract

As transcatheter aortic valve replacement (TAVR) expands to lower-risk populations, understanding contemporary patterns of complications requiring surgical intervention remains critical. This study examines the incidence, predictors, and outcomes of major TAVR complications.

The National Inpatient Sample (2016-2021) was queried to identify adult patients undergoing TAVR. Major complications were defined as surgical aortic valve replacement, coronary artery bypass grafting, aortic intervention, pericardial drainage, VA-ECMO, cardiac repair, or diagnosis of aortic dissection/rupture. Multivariable logistic regression identified predictors of complications and failure-to-rescue.

Among 383 395 TAVRs, 4685 (1.2%) experienced major complications. Overall in-hospital mortality was 1.3%. Mortality was 26.0% in patients with major complications versus 1.0% without (P < .001). Stroke rates were also higher in patients with major complications (7.5% versus 1.8%, P < .001). Complications were associated with longer length of stay (8 vs 2 days) and higher hospital costs ($79,302 vs $45,469). Independent predictors of complications included age <65 (OR 2.27), bicuspid aortic valve (OR 1.79), thoracic aortic aneurysm (OR 1.49) and female sex (OR 1.24), while elective admission was protective (OR 0.51). Among patients with complications, VA-ECMO cannulation (OR 10.36), cardiac chamber repair (OR 3.14), and aortic dissection/rupture (OR 1.68) were strongest predictors of mortality.

While the proportion of TAVR patients experiencing surgical emergencies has remained stable over time, the overall prevalence is increasing with the growth of TAVR, and these complications are associated with an in-hospital mortality rate of greater than 25%. Younger age, female sex, bicuspid valve, and thoracic aneurysm are associated with increased risk of major complications.

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis, and its utilization has increased rapidly in the United States over the last decade.

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