In-hospital outcomes of elective TAVR complicated by cardiogenic shock: A report from the national inpatient sample
Ranka S, Syed M, and Villablanca P. In-hospital outcomes of elective TAVR complicated by cardiogenic shock: A report from the national inpatient sample. Catheter Cardiovasc Interv 2019; 93(Suppl 2):S169-S171.
Catheter Cardiovasc Interv
Background: Cardiogenic shock (CS) is an important complication after transcatheter aortic valve replacement (TAVR) but has limited reported data. We sought to study the incidence, outcomes and management CS post TAVR. Methods: We queried the National Inpatient Sample from Jan 2012 to Sept 2015 for patients undergoing elective TAVR complicated by CS using appropriate ICD9 codes. Primary outcomes of interest were allcause mortality with other outcomes as mentioned in Table 1. Procedure-related death was defined as death within 24-hours of TAVR. Multivariate logistic regression was done to evaluate for predictors of mortality. Results: Out of 51685, 430 patients (0.8%) developed CS post TAVR. Mean age was 80.9 years with 57% females. All-cause inpatient mortality was 31.4% with 25.9% of these patients having procedure-related death. There was a steady increase in incidence of CS from 11.6% in 2012 to 37.2% in 2015. Need for mechanical circulatory support (MCS) was 33.7%, with intra-aortic balloon pump being the most common device (72.4%). All other in-hospital complications are as shown in Table 1. Need for mechanical ventilation, development of multiorgan failure and need for MCS support were significant predictors of mortality in CS cohort. Conclusions: The development of CS post TAVR is relatively low with high in hospital mortality. About one-fourth of patients suffered procedure-related death, with respiratory failure being a significant predictor of overall mortality. Further research is warranted for better management of such patients. (Table Presented).