Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions Database
<b>Background</b>: 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, conductio...
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2025-05-01
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| author | Vivek Joseph Varughese Vignesh Krishnan Nagesh Hadrian Hoang-Vu Tran Olivia Yessin Harsh Jha Ashley Mason Audrey Thu Simcha Weissman Adam Atoot |
| author_facet | Vivek Joseph Varughese Vignesh Krishnan Nagesh Hadrian Hoang-Vu Tran Olivia Yessin Harsh Jha Ashley Mason Audrey Thu Simcha Weissman Adam Atoot |
| author_sort | Vivek Joseph Varughese |
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| description | <b>Background</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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, <i>p</i> < 0.001) and chronic heart failure (OR 2.73, <i>p</i> < 0.001). Left bundle branch block (LBBB) was strongly associated with complete heart block (OR 12.89, <i>p</i> < 0.001) and heart failure readmissions (OR 7.65, <i>p</i> < 0.001). <b>Conclusions</b>: 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. |
| format | Article |
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| spelling | doaj-art-8d92c009ec954f40b95a8e41d27c27182025-08-20T03:14:46ZengMDPI AGDiseases2079-97212025-05-0113514910.3390/diseases13050149Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions DatabaseVivek Joseph Varughese0Vignesh Krishnan Nagesh1Hadrian Hoang-Vu Tran2Olivia Yessin3Harsh Jha4Ashley Mason5Audrey Thu6Simcha Weissman7Adam Atoot8Department of Internal Medicine, University of South Carolina, Prisma Health, Columbia, SC 29201, USADepartment of Internal Medicine, University of South Carolina, Prisma Health, Columbia, SC 29201, USADepartment of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USADepartment of Internal Medicine, University of South Carolina, Prisma Health, Columbia, SC 29201, USADepartment of Internal Medicine, University of South Carolina, Prisma Health, Columbia, SC 29201, USADepartment of Internal Medicine, University of South Carolina, Prisma Health, Columbia, SC 29201, USATouro College of Medicine, New York, NY 10027, USADepartment of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USADepartment of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA<b>Background</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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, <i>p</i> < 0.001) and chronic heart failure (OR 2.73, <i>p</i> < 0.001). Left bundle branch block (LBBB) was strongly associated with complete heart block (OR 12.89, <i>p</i> < 0.001) and heart failure readmissions (OR 7.65, <i>p</i> < 0.001). <b>Conclusions</b>: 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.https://www.mdpi.com/2079-9721/13/5/149TAVRaortic stenosisnational inpatient samplenational readmission databasestrokeheart failure |
| spellingShingle | Vivek Joseph Varughese Vignesh Krishnan Nagesh Hadrian Hoang-Vu Tran Olivia Yessin Harsh Jha Ashley Mason Audrey Thu Simcha Weissman Adam Atoot Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions Database Diseases TAVR aortic stenosis national inpatient sample national readmission database stroke heart failure |
| title | Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions Database |
| title_full | Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions Database |
| title_fullStr | Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions Database |
| title_full_unstemmed | Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions Database |
| title_short | Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions Database |
| title_sort | trends and outcomes of tavr an analysis using the national inpatient sample and readmissions database |
| topic | TAVR aortic stenosis national inpatient sample national readmission database stroke heart failure |
| url | https://www.mdpi.com/2079-9721/13/5/149 |
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