Transcatheter aortic valve replacement at metropolitan teaching hospitals among patients with heart failure

Heart failure is highly prevalent among patients undergoing transcatheter aortic valve replacement (TAVR). Prior literature well documents an increased risk of readmission in heart failure patients undergoing TAVR; however, data comparing clinical outcomes between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) in this population remain limited.

We conducted a retrospective analysis using the Nationwide Readmissions Database (NRD) from 2016 to 2022. Patients undergoing TAVR at metropolitan teaching hospitals were identified and stratified into two cohorts: HFrEF and HFpEF. The primary outcome was the 30-day all-cause readmission rate. Secondary outcomes included in-hospital complications and all-cause in-hospital mortality.

Among 120,199 patients undergoing TAVR, 16.25% had HFrEF and 83.75% had HFpEF. The HFrEF cohort had higher baseline comorbidities, including peripheral vascular disease, prior myocardial infarction, and chronic kidney disease. After adjusting for baseline comorbidities, the HFrEF cohort experienced higher rates of in-hospital complications, including mechanical circulatory support, cardiogenic shock, acute heart failure, extracorporeal membrane oxygenation, cardiopulmonary resuscitation, acute myocardial infarction, valvular complications, mechanical ventilation, intubation, and acute kidney injury, as well as higher in-hospital mortality. The 30-day all-cause readmission rate among survivors was also higher in the HFrEF cohort (11.29% vs. 9.74%; HR: 1.142, 95% CI: 1.127-1.156; p < 0.001).

HFrEF was associated with worse in-hospital and early post-discharge outcomes following TAVR compared with HFpEF. Further studies are warranted to identify targeted strategies to mitigate risk in this high-risk population.