E-12 | In-Hospital Outcomes of Transcatheter Aortic Valve Implantation in Patients with Coexisting Heart Failure

Transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis (AS) in the last 2 decades. However, with worsening stenosis, the patient develops diastolic dysfunction & heart failure (HF) due to increased afterload. We aim to compare if TAVI is an effective option even after the HF develops. The national readmission database (2016-2020) was utilized to identify hospitalizations for TAVI. Cohorts were stratified by the presence of HF. A propensity score matching (PSM) model matched patients with & without HF. Pearson's x2 test was applied to PSM-2 matched cohorts to compare outcomes. Among, 320,304 hospitalizations for TAVI; the large majority (N: 231,497; 72.3%) had co-existing HF. After propensity matching (N=126,528), HF patients were found to have higher in-hospital mortality (1.6% vs 1.2%, aOR:1.36) acute myocardial infarction (4.5% vs 1.9%, aOR:2.3), sudden cardiac arrest (1% vs 0.7%, aOR:1.14), cardiogenic shock (2.4% vs 0.8%, aOR: 2.8), mechanical circulatory support (1% vs 0.4%, aOR:2.18) & pressor (2.8% vs 1.4%, aOR:1.55) requirement, AKI (12% vs 7.3%, aOR:1.92), acute respiratory failure (5.6% vs 2.2%, aOR:2.6) & major adverse cardiac events (7.9% vs 5.1%, aOR:1.5) [p<0.001] From 2016-2020; peri-procedural mortality of TAVR has decreased from 1.6% to 1.2% (p-trend:0.006) Patients with HF also have longer LOS and resource utilization (p<0.05). In severe Aortic stenosis, the development of HF is a strong predictor of higher mortality and worse clinical outcomes after TAVI implantation.