Transcatheter Aortic Valve Replacement in Patients with Coronary Chronic Total Occlusion

Coronary artery disease is a common diagnosis among patients evaluated for transcatheter aortic valve replacement (TAVR). It is unknown whether the presence of coronary artery chronic total occlusion (CTO) has any impact on TAVR post-procedural in-hospital outcomes.

The study population was extracted from the 2016 Nationwide Readmissions Data using International Classification of Diseases, tenth edition, clinical modifications/procedure coding system codes for TAVR, coronary CTO and post-procedural complications. Study endpoints included in-hospital all-cause mortality, length of index hospital stay, paravalvular leak (PVL), mechanical complications of prosthetic valve, cardiogenic shock, acute myocardial infarction (AMI), acute kidney injury (AKI), need for a permanent pacemaker, and bleeding. Propensity matching was used to extract a matched control (TAVR-M group to TAVR-CTO group).

There were 23,604 TAVR, of whom, 467 discharges were identified in each group. Baseline characteristics and comorbidities were comparable. Mean age was 80.5 years and 45.9% were female. In comparison to TAVR-M, TAVR-CTO was associated with longer length of stay (8.1 versus 5.9 days, p < 0.01), and higher incidence of post-procedural cardiogenic shock (5.1% versus 1.7%, p < 0.01), AMI (5.8% versus 2.8%, p = 0.02), and AKI (18.6% versus 13.9, p = 0.048). There was no significant difference between the two groups in in-hospital all-cause mortality (1.7% versus 2.4%, p = 0.49), PVL (1.3% versus 0.4%, p = 0.16), mechanical complications of prosthetic valve (0.4% versus 0.9%, p = 0.41), permanent pacemaker (11.6% versus 8.1%, p = 0.07), or bleeding (20.6% versus 19.7%, p = 0.74).

In comparison to TAVR-M, TAVR-CTO was associated with a higher incidence of cardiogenic shock, AMI, and AKI and longer LOS but similar mortality.