Impact of Non-Cyanotic Congenital Heart Disease in the Patients Undergoing Transcatheter Aortic Valve Replacement: A Nationwide Inpatient Sample Analysis

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Introduction: Reported total congenital heart disease (CHD) birth prevalence has increased substantially over time. It varies from 1.9 to 9.3 per 1000 live births based on geographic location. Aortic stenosis(AS) is a common pathology associated with advanced age. It is found to be in the 11.7-15.0% population over 75-year-old cohort. TAVR is the preferred intervention for severe AS patients. It is now being performed in extreme- to low-risk patients. We sought to determine the impact of non-cyanotic CHD in the patients undergoing TAVR.

Method: We reviewed National Inpatient Sample (NIS) database from 2016-2018 using Stata 16.0. The NIS is the ICD-10-CM code-based healthcare database. Patients who underwent TAVR were identified and divided into with and without CHD. Multivariate logistic regression, linear regression, and student t-tests were used for analysis.

Results: Among 134,195 patients who underwent TAVR, 1,135(0.9%) were having NCHD. Patients with NCHD were younger (77.9±11.2 vs. 79.6±8.4 with P=0.02) with equal gender distribution. NCHD patients had longer lengths of stay than others (5.9±6.3 vs. 4.3±5.4 with P=<0.001) and were associated with higher co-morbidities such as anemia, atrial fibrillation, and pulmonary hypertension. 55 (4.9%) patients died in the NCHD group, whereas 1956 (1.5%) patients died in the other. The difference was found to be statistically significant on multivariant logistic regression analysis. (OR:2.9, 95%-Confidence Interval: 1.6-5.3, P=<0.001). Complications such as post-operative shock, AMI, AKI, bleeding requiring transfusion, acute respiratory failure, cardiogenic shock, and pacemaker implantation were comparable between both groups. The mean total charge for the NCHD group was $68688, whereas others were $ 54794.

Conclusion: NCHD was associated with higher in-patient mortality and LOS in the patients undergoing TAVR for severe AS. However, Complications were comparable in patients with and without NCHD.