Transcatheter Aortic Valve Implantation Readmissions in the Current Era (from the National Readmission Database).

ABSTRACT

Transcatheter aortic valve implantation (TAVI) has become the mainstream treatment for severe aortic stenosis. Despite improvement in device iteration and operator experience rigorous outcome data outside the scope of clinical trials is lacking. Nationwide readmission database 2016 and 2017 was utilized to identify the study population. International Classification of Disease,10th edition codes were used to identify TAVI admissions. Outcomes of interest were the 90-day readmission pattern and in hospital complications of the TAVI procedure. A total of 73,784 TAVI related index admissions were identified in the Nationwide Readmission Database in 2016 to 2017. Forty four percent of patients undergoing TAVI in that timeframe were discharged within 48 hours of their procedure. 16,343 patients (22.2%) were readmitted within 90 days after discharge. Major cardiac co-morbidities like heart failure were prevalent more often in the group of patients that were readmitted within 90 days. Noncardiac causes however accounted for two thirds of these readmissions. The median time to 90-day readmission was 31 days. Multivariate analysis showed that nonagenarians, patients undergoing transapical TAVI, and patients with a higher comorbidity burden were more likely to be readmitted within 90 days. In conclusion, almost half of TAVI patients in the US are discharged within 48 hours after their procedure and 20% of all TAVI patients are readmitted within 90 days. Most readmissions are due to noncardiac causes.