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Central Surgical Association

49th Annual Meeting

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All-Cause Procedural Readmissions Following Transcatheter Aortic Valve Replacement
Paige Newell1, Hoda Javadikashari1, Mehida Rojas-Alexandre1, Sameer Hirji1, Morgan Harloff1, Olena Cherkasky1, Siobhan McGurk1, Alexandra Malarczyk1, Ashraf Sabe1, Pinak Shah2, Tsuyoshi Kaneko1
1Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States, 2Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States

OBJECTIVE: With expanding eligibility criteria, transcatheter aortic valve replacement (TAVR) is being performed on an increasing number of patients. As a result, subsequent interventions following index TAVR is inevitable in some patients. This study examines the incidence and outcomes of patients undergoing subsequent procedural readmissions following TAVR.

METHODS: All patients who underwent index TAVR from January 2012-December 2019, at a single institution were evaluated. Patients with operative mortality were excluded as they were not at risk for procedural readmission. Study endpoints were mortality and readmission for procedure with >1 day hospital stay. Follow-up was calculated in days from TAVR to study end (May 2021) or event. Effect on survival was evaluated treating readmission as a time dependent variable, by Cox proportional hazard model. A competing risk analysis for procedural readmission vs mortality was performed. A total of 390 deaths and 218 patients were identified.

RESULTS: A total of 1,092 patients met inclusion criteria, with a median follow-up time of 33 months for a total of 3,264 patient years. The overall mean age was 79.1 years, mean Society of Thoracic Surgeons Predicted Risk of Mortality (PROM) was 5.1%, and 44% of patients were female. A total of 218 (20.0%) patients had a subsequent procedural readmission during the study period. Of the 259 procedures, 95 (36.7%) were cardiac [median time-to-intervention 10.1 months] comprised of 20 (7.7%) coronary, 18 (6.9%) aortic valve, 9 (3.5%) mitral valve, 41 (15.8%) pacemaker implantations, and 7 (2.7%) other cardiac interventions. 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. After 3 years postoperatively from index TAVR, the risk of death exceeds the risk of readmission. On Cox regression, procedural readmissions were not associated with a significant survival penalty (HR=1.26 [0.98, 1.63], p=0.073)]. A subgroup analysis of just cardiac procedural readmissions also were not associated with a survival penalty. When stratified by surgical risk, there continued to be no significant survival penalty for procedural readmissions in the low (PROM=<3%), intermediate (PROM 3-8%), and high (PROM>=8%) risk subgroups, and the overall rates of procedural readmission did not differ being risk groups (p=0.69).

CONCLUSION: Following TAVR, procedural interventions happen frequently with most procedures occurring within the first year post-TAVR, and over 40% of patients having a procedure within 5 years. However, TAVR patients who undergo a subsequent procedure have similar overall survival as TAVR patients that do not have subsequent procedures, even in cardiac procedures. The mechanism of mortality after TAVR cannot be explained by subsequent procedural readmissions and needs further investigations.

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