Endovascular Transcatheter Aortic Valve Replacement Outcomes in Hypertrophic Cardiomyopathy: Insights from the National Inpatient Sample (2014–2018)

Abstract

Background: Outcomes of patients with hypertrophic cardiomyopathy (HCM) following transcatheter aortic valve replacement (TAVR) remain largely unknown. Objectives: This study sought to assess the clinical characteristics and outcomes of HCM patients following TAVR. Methods: We queried the National Inpatient Sample from 2014 to 2018 for TAVR hospitalizations with and without HCM, creating a propensity-matched cohort to compare outcomes. Results: 207,880 patients that underwent TAVR during the study period, 810 (0.38%) had coexisting HCM. In the unmatched population, TAVR patients with HCM compared to those without HCM, were more likely to be female, had a higher prevalence of heart failure, obesity, cancer, and history of pacemaker/implantable cardioverter defibrillation, and were more likely to have nonelective and weekend admissions (p for all <0.05). TAVR patients without HCM had higher prevalence of coronary artery disease, prior percutaneous coronary intervention, prior coronary artery bypass grafting, and peripheral arterial disease compared to their counterparts (p for all <0.05). In the propensity-matched cohort, TAVR patients with HCM had significantly higher incidence of in-hospital mortality, acute kidney injury/hemodialysis, bleeding complications, vascular complications, permanent pacemaker requirement, aortic dissection, cardiogenic shock, and mechanical ventilation requirement. Conclusion: Endovascular TAVR in HCM patients is associated with an increased incidence of in-hospital mortality and procedural complications.

Aortic Stenosis Associated with Hypertrophic Cardiomyopathy: A Double Trouble

“…After analyzing the entire cohort for the differences between the two conditions (i.e., TAVI in patients with vs. without HCM), the authors performed a 3:1 propensity matching analysis in 2,430 patients who underwent TAVI without HCM and compared them with 810 patients who underwent TAVI in the presence of HCM. The AS/HCM cohort had a 7-fold higher incidence of in-hospital mortality, more than 4-fold increase in aortic dissection incidence, and more than 3-fold higher incidence of cardiogenic shock and vascular complications [5]. Due to the nature of data collection, important information is missing as the presence, severity, and type of LVOT obstruction (i.e., at rest or provoked), the presence and severity of mitral regurgitation, the type and size of the prosthetic valve implanted, and the long-term outcome.…”