Utilization and Outcomes of Structural Heart Disease Interventions in Patients With Prior Mediastinal Radiation

Outcomes of structural heart disease (SHD) interventions may be affected by prior mediastinal radiation.

The objective of the study was to evaluate the outcomes of SHD interventions among patients with vs without prior mediastinal radiation.

We analyzed the Nationwide Readmissions Database (2016-2022) to identify patients aged ≥18 years with prior mediastinal radiation who underwent SHD interventions. The primary outcome was in-hospital mortality. Secondary outcomes included procedural complications, resource utilization (length of stay, costs, discharge disposition), and 90-day readmissions. In-hospital outcomes were analyzed with logistic regression and readmissions with Cox proportional hazards models.

Among 810,849 weighted hospitalizations for transcatheter aortic valve replacement, mitral transcatheter edge-to-edge repair, transcatheter mitral valve replacement, and left atrial appendage occlusion, 1.3% included patients with prior mediastinal radiation. Utilization rates (procedures/100,000 hospitalizations) were higher in patients with vs without prior mediastinal radiation for transcatheter aortic valve replacement (577 vs 254), mitral transcatheter edge-to-edge repair (70 vs 35), and transcatheter mitral valve replacement (11 vs 4) (all P < 0.001). There were no significant differences in adjusted in-hospital mortality, complications, or resource utilization between patients with vs without prior mediastinal radiation following any of the 4 SHD interventions. Ninety-day readmissions were similar after transcatheter aortic and mitral valve interventions but higher after left atrial appendage occlusion (adjusted HR: 1.51; 95% CI: 1.21-1.89) in patients with vs without prior mediastinal radiation.

Transcatheter aortic and mitral valve interventions are performed more frequently in patients with vs without prior mediastinal radiation with similar in-hospital outcomes and readmissions. Readmissions after LAAO are higher in patients with vs without prior mediastinal radiation.