All-cause procedural readmissions following transcatheter aortic valve replacement

Paige Newell; Hoda Javadikasgari; Mehida Rojas-Alexandre; Sameer Hirji; Morgan Harloff; Olena Cherkasky; Siobhan McGurk; Alexandra Malarczyk; Pinak Shah; Ashraf Sabe; Tsuyoshi Kaneko

doi:10.1016/j.xjon.2023.05.017

All-cause procedural readmissions following transcatheter aortic valve replacement

JTCVS Open. 2023 Jul 24:15:83-93. doi: 10.1016/j.xjon.2023.05.017. eCollection 2023 Sep.

Affiliations

¹ Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
² Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
³ Division of Cardiac Surgery, Washington University School of Medicine, St Louis, Mo.

Abstract

Objective: With expanding eligibility criteria, transcatheter aortic valve replacement is being performed on patients with longer life expectancy, and subsequent procedures after index transcatheter aortic valve replacement are inevitable. This study examines the incidence and outcomes of patients undergoing subsequent procedural readmissions after transcatheter aortic valve replacement.

Methods: All patients who underwent index transcatheter aortic valve replacement and were discharged alive from January 2012 to December 2019 at a single institution were evaluated. Study end points were mortality and readmission for procedure with more than 1-day hospital stay. Effect on survival was evaluated by treating procedural readmission as a time-dependent variable by Cox proportional hazard model and competing risk analysis.

Results: A total of 1092 patients met inclusion criteria with a median follow-up time of 34 months. A total of 218 patients (20.0%) had 244 subsequent procedural readmissions. During the 244 procedural readmissions, there were 260 procedures; 96 (36.9%) were cardiac (most commonly pacemaker implantation, percutaneous coronary interventions, and surgical aortic valve replacements), and 164 (63.1%) were noncardiac (most commonly orthopedic and gastrointestinal procedures). The overall procedural readmission rates were 32%, 39%, and 42%, and all-cause mortality was 27%, 44%, and 54% at 20, 40, and 60 months, respectively. Procedural readmissions were not associated with a survival penalty in any surgical risk group or on Cox regression (hazard ratio, 1.25; 0.91-1.64, P = .17).

Conclusions: After transcatheter aortic valve replacement, procedural interventions are seen frequently, with most procedures occurring within the first year after transcatheter aortic valve replacement. However, subsequent procedural readmissions do not appear to have a survival penalty for patients after transcatheter aortic valve replacement. After transcatheter aortic valve replacement with resolution of aortic stenosis, subsequent procedures can and should be pursued if they are needed.

Keywords: aortic valve replacement; outcomes; readmissions; subsequent procedures, TAVR; transcatheter.