30-DAY READMISSIONS AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT

Background: As the number of centers performing Transcatheter Aortic Valve Replacement (TAVR) continue to proliferate, it has become increasingly important to minimize costs associated with readmissions following this procedure, which requires up-to-date data on 30 day readmissions. Methods: Using the 2016 National Readmissions Database (NRD), we used ICD-10 codes to identify patients who had TAVR procedure and separated them into two groups based on whether they had tricuspid vs bicuspid aortic valve. Baseline characteristics of patients as well as incidence and causes of 30-day readmissions were identified. Results: 16700 index admissions were identified and the overall 30 day readmission rate among all patients was 13.6% (2284 patients). Out of these readmissions, there were 2276 (99.6%) tricuspid aortic valve patients and 8 (3.5%) bicuspid aortic valve patients. The most common cause of readmission in tricuspid valve patients was heart failure (17.6%). This was followed by arrhythmias (11.2%), sepsis (6.7%), gastrointestinal bleed (4.6%), and renal failure (2.2%). Other cardiac causes of readmission in this group were complication of cardiovascular device (2.1%), myocardial infarction (1.8%), aortic or peripheral aneurysms (1%), and pericarditis (0.9%). In the bicuspid aortic valve group, chest pain and arrhythmias were the major causes of readmission. Independent predictors of 30 day readmission were acute kidney injury (OR 1.98; 95% CI, 1.73-2.26), chronic kidney injury (OR 1.53; 95% CI, 1.38-1.70), and Elixhauser comorbidity score more than 4 (OR 1.75; 95% CI, 1.32-2.33). Conclusion: 30 day readmissions after TAVR in 2016 NRD was 13.6%, which is reduced compared to large studies from prior years, which showed readmissions rate of 17.9% (Kolte et al) and 16% (Danielsen et al). Renal failure and Elixhauser comorbidity score are risk factors associated with readmissions. Heart failure and arrhythmia are significant cardiac causes of readmission as well as potential areas requiring improvement and careful monitoring.