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In-hospital outcomes of TAVR patients with a bundle branch block: Insights from the National Inpatient Sample
Salman Zahid1, Muhammad Z Khan2, Waqas Ullah3
1Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA.
Insights
Transcatheter aortic valve replacement (TAVR) patients with bundle branch block (BBB) require more pacemakers. Right BBB is the strongest predictor for pacemaker implantation after TAVR, though rates are improving.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Limited data exists on transcatheter aortic valve replacement (TAVR) outcomes in patients with bundle branch block (BBB).
- Bundle branch block is a common finding in patients undergoing TAVR.
- Understanding the impact of BBB on TAVR outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the outcomes of TAVR in patients with and without bundle branch block.
- To identify predictors of permanent pacemaker (PPM) implantation after TAVR.
- To analyze trends in PPM implantation, length of stay, and hospitalization costs.
Main Methods:
- Retrospective analysis of the National Inpatient Sample (NIS) database from 2011 to 2018.
- Inclusion of patients who underwent TAVR, categorized by the presence and type of BBB (RBBB, LBBB).
- Utilized ICD-9-CM and ICD-10-CM codes for data extraction and analysis.
Main Results:
- 194,237 TAVR patients were analyzed; 1.7% had RBBB and 13.7% had LBBB.
- Patients with RBBB (31.5%) and LBBB (15.7%) had higher rates of new PPM implantation compared to those without BBB (10.2%).
- RBBB was associated with longer hospital stays and higher costs; however, PPM rates, length of stay, and costs decreased over time for all groups.
Conclusions:
- Patients with BBB undergoing TAVR have increased rates of new PPM implantation.
- Right BBB is the strongest independent predictor for PPM implantation post-TAVR.
- Despite improvements, further research is needed to minimize PPM implantation risks in TAVR patients.
Introduction:
Data on the outcomes following transcatheter aortic valve replacement (TAVR) in patients with a bundle branch block (BBB) remains limited.
Methods:
We studied the outcomes of TAVR patients with a BBB from the National Inpatient Sample (NIS) database between 2011 and 2018 using ICD-9-CM and ICD-10-CM codes.
Results:
Between 2011 and 2018, 194,237 patients underwent TAVR, where 1.7% (n = 3,232) had a right BBB (RBBB) and 13.7% (n = 26,689) had a left BBB (LBBB). Patients with a RBBB and LBBB had a higher rate of new permanent pacemaker (PPM) implantation (31.5% - RBBB, 15.7% LBBB vs. 10.2% - no BBB). RBBB was associated with a significantly longer median length of stay (5 days) and total hospitalization cost ($53,669) compared with LBBB (3 days and $47,552) and no BBB (3 days and $47,171). Trend analysis revealed lower rates of PPM implantation and reduced lengths of stay and costs across all comparison groups.
Conclusion:
In conclusion, patients undergoing TAVR with a BBB are associated with higher new rates of PPM implantation. RBBB is the strongest independent predictor for new PPM implantation following TAVR. Rates of new PPM implantation in TAVR patients with and without a BBB have improved over time including reductions in length of stay and hospital costs. Further study is needed to reduce the risks of PPM implantation in TAVR patients.
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