Patients who undergo transcatheter aortic valve replacement (TAVR) and a mitral procedure during the same hospital visit face a heightened risk of poor outcomes, according to new findings published in JACC: Cardiovascular Interventions.
Researchers used the National Readmissions Database to track data from more than 210,000 hospitalizations for TAVR from 2014 to 2018. During a small number of those hospitalizations—just 0.09%, to be exact—the patient also underwent either transcatheter edge-to-edge repair (TEER), formerly known as transcatheter mitral valve repair, or transcatheter mitral valve replacement (TMVR). In general, the team noted, patients chosen to undergo TAVR and a mitral procedure during the same hospital visit tended to be younger than patients who underwent just TAVR.
Compared to patients only undergoing TAVR, patients undergoing TAVR and TEER during the same hospital visit were more likely to have heart failure, pulmonary circulation disorders, diabetes, coagulopathy, cardiogenic shock and nonelective admission. However, they were less likely to be obese.
In-hospital mortality was also much lower (1.9% vs. 10.8%) for patients undergoing just TAVR as opposed to TAVR and TEER. Patients undergoing both procedures also faced a higher risk of cardiac arrest, the use of mechanical circulatory support, acute kidney injury (AKI), new hemodialysis, major bleeding, blood transfusion and a discharge to a nursing facility.
In addition, patients undergoing TAVR and TMVR during the same hospital visit were more likely to have chronic dialysis, heart failure and liver disease than patients undergoing only TAVR. These patients were less likely to have hypertension or a prior myocardial infarction.
In-hospital mortality was much lower (1.9% vs. 13.3%) for patients undergoing just TAVR than those undergoing TAVR and TMVR. Patients undergoing both procedures also faced a higher risk of needing mechanical circulatory support, being discharged to a nursing facility or experiencing an AKI.
“The higher risk of in-hospital mortality associated with combined transcatheter interventions for aortic stenosis and mitral regurgitation is likely multifactorial and related to cumulative risk of the two procedures in the elderly and often frail patients, increased burden of comorbidities and higher frequency of nonelective admissions (in the TEER group) indicative of a sicker patient population compared with those undergoing elective TAVR alone,” wrote lead author Ayman Elbadawi, MD, department of cardiovascular medicine at Houston Methodist Hospital, and colleagues. “In light of our study results, further studies are warranted to evaluate the optimal treatment approach for patients with residual MR after undergoing TAVR. The current study is limited by the observational nature of the dataset and the lack of imaging and procedural details.”
Click here to read the full analysis.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.