April 27, 2026Journal of Cardiothoracic Surgery0 citationsOpen Access

Trend and clinical outcomes of transcatheter aortic valve replacement in connective tissue disease from the national inpatient sample database (2016–2022)

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Aortic stenosis with connective tissue disease (n=90298). Intervention: Transcatheter aortic valve replacement (TAVR) in patients with connective tissue disease vs. TAVR in patients without connective tissue disease. Primary outcome: In-hospital mortality (p=0.345).

FYFarah YasminAdventHealth Sebring ARasad ur rabTrinity Health MAMuhammad Sohaib AsgharMayo Clinic

Key Result

In patients undergoing transcatheter aortic valve replacement, those with connective tissue disease had comparable in-hospital mortality to those without the disease (1.0% vs. 1.2%, p=0.345).

Key Points

This study aims to evaluate the safety and clinical outcomes of transcatheter aortic valve replacement in patients with connective tissue disease.
Data sourced from the national inpatient sample database from 2016 to 2022.
Analysis compared outcomes of patients with connective tissue disease to those without.
TAVR shows comparable clinical outcomes in patients with CTD versus those without.
Overall safety profile supports the use of TAVR in the CTD population.

Study Design

Type

Observational (n=90,298)

Multicenter

Yes

Structured PICO

Does TAVR have comparable in-hospital outcomes in patients with connective tissue disease compared to those without?

Population

90,298 adults (≥18 years) who underwent transcatheter aortic valve replacement (TAVR) between 2016 and 2022 in the United States (National Inpatient Sample database), including 3,821 (4.2%) with a diagnosis of connective tissue disease (CTD). Mean age ~78.4 years, 65.3% female in the CTD cohort.

Intervention

Transcatheter aortic valve replacement (TAVR) in patients with connective tissue disease (CTD)

Comparator

Transcatheter aortic valve replacement (TAVR) in patients without connective tissue disease

Outcome

In-hospital mortality, length of stay, and inflation-adjusted hospitalization costshard clinical

TAVR is a safe and feasible therapeutic option for patients with connective tissue disease, demonstrating comparable in-hospital mortality and complication rates to patients without the disease.

Main Result

Absolute Event Rate: 1% vs 1.2%

p-value: p=0.345

Limitations

Reliance on ICD-10 coding may introduce misclassification bias due to variability in coding practices
The NIS lacks detailed clinical and procedural data, including valve type and size, access route, severity of aortic stenosis, and frailty measures
Outcomes are limited to in-hospital events without long-term follow-up
Selection bias and referral bias, as CTD patients undergoing TAVR may represent a highly selected subgroup treated at experienced centers
Potential for type I error due to the large sample size where small absolute differences may achieve statistical significance
Subgroup analyses by specific CTD subtype were not performed due to limited sample size

Abstract

Overall, TAVR appears to be a safe and feasible therapeutic option in patients with CTD, with outcomes comparable to those without CTD.

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