Key result
Pre-procedural LBBB is linked to ~13-fold greater risk of complete heart block readmission after TAVR.
Why the study?
Despite expanding TAVR indications, post-procedural complications such as stroke, conduction disturbances, and heart failure readmissions remain concerns, warranting analysis of national trends, outcomes, and readmission risk factors.
Observational (n=123,376)
Yes
While TAVR in-hospital mortality and length of stay have decreased, 60-day readmissions remain high, predominantly driven by heart failure and conduction disturbances strongly associated with pre-existing bundle branch blocks.
High post-TAVR readmission risk with pre-procedural LBBB may warrant closer surveillance; observational data leaves open whether targeted interventions reduce events.
Background: Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis in high- and intermediate-risk patients, with expanding indications for lower-risk populations. However, post-procedural complications, such as stroke, conduction disturbances, and heart failure readmissions, remain concerns. The aim of our study is to analyze the national trends in TAVR procedures, in-hospital outcomes, major readmission causes, and the association of risk factors for readmissions following TAVR. Methods: We analyzed NIS data (2018–2022) to assess TAVR utilization trends, patient demographics, and in-hospital outcomes. The NRD (2021–2022) was used to evaluate 60-day readmission rates for stroke, complete heart block, and heart failure. Multivariate regression models were employed to identify risk factors having significant association with major readmission causes. Results: TAVR utilization increased from 10,788 cases in 2018 to 17,784 in 2022, with a concurrent decrease in in-hospital mortality (1.33% to 0.90%) and length of stay (3.88 to 2.97 days). Of 123,376 TAVR index admissions in 2021, 28,654 patients had 66,100 readmission events (53.57%) in the 60 days following discharge. Heart failure (17,566 cases, 26.57% of readmissions) was the most common readmission cause, followed by complete heart block (1760 cases, 2.66% of readmissions) and stroke (284 cases, 0.42% of readmissions). Predictors of post-TAVR stroke included uncontrolled hypertension (OR 2.29, p < 0.001) and chronic heart failure (OR 2.73, p < 0.001). Left bundle branch block (LBBB) was strongly associated with complete heart block (OR 12.89, p < 0.001) and heart failure readmissions (OR 7.65, p < 0.001). Conclusions: TAVR utilization has increased with improving perioperative outcomes, but post-TAVR readmissions remain significant, particularly for heart failure, stroke, and conduction disturbances. Pre-procedural uncontrolled hypertension, hyperlipidemia, congestive heart failure, and atrial fibrillation were risk factors with significant association with stroke in the 60 days following TAVR. The presence of documented pre-procedural LBB, RBB, as well as BFB were risk factors with significant association with complete heart block following TAVR placements. Pre-procedural LBB, RBB, BFB, and atrial fibrillation were risk factors having significant association with heart failure readmissions in the 60 days following TAVR.
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Varughese et al. (2025) conducted an observational in Severe aortic stenosis (n=123,376). Transcatheter aortic valve replacement (TAVR) was evaluated on 60-day readmission events. Post-TAVR 60-day readmission events occurred at a rate of 53.57%, most commonly for heart failure, with pre-procedural LBBB strongly predicting complete heart block readmission (OR 12.89, p<0.001).
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