Abstract
Introduction: TAVR is widely accepted for the management of symptomatic severe aortic stenosis (AS), but its use in rheumatic heart disease has been limited. We sought to investigate the in-hospital outcomes of patients undergoing TAVR for symptomatic severe rheumatic AS. Methods: This is a retrospective NIS Database search from 2012 to 2017 to identify patients with ICD-9 and10 procedure codes for TAVR and for rheumatic AS. We compared baseline characteristics, procedure characteristics, in-hospital mortality and length of hospitalization based on the presence or absence of rheumatic AS. Results: From a total of 32,273 patients who underwent TAVR, the incidence of non-rheumatic severe AS was 6.54%. Baseline characteristics are displayed in Table 1. All-cause mortality was similar between both groups (2.3% vs. 2.4%, p=0.780) but length of stay (days) was significantly higher in the rheumatic AS group (6.1 ± 7 vs. 5.8 ± 6.4, p<0.001). Rates of Paravalvular Leak (1.1% vs. 0.7%, p<0.05) and post-procedure ischemic stroke (5.3 vs. 2.0%, p<0.001) were higher in patients with non-rheumatic AS. Using a multivariate logistic regression model, this cohort did not reveal increased odds of in hospital mortality based on the presence of severe rheumatic AS after adjusting for confounders (OR-0.97, 95% CI 0.69 to 1.37, p=0.867). Conclusions: This retrospective cohort demonstrated that TAVR may be feasible for rheumatic severe AS. Despite an older population than reported in the literature, mortality rates, complications and hospital length of stay was comparable to patients undergoing TAVR for calcific aortic disease. Further randomized studies are needed to support these findings.
