J Clin Neurol.  2017 Oct;13(4):351-358. 10.3988/jcn.2017.13.4.351.

Perioperative Stroke, In-Hospital Mortality, and Postoperative Morbidity Following Transcatheter Aortic Valve Implantation: A Nationwide Study

• Thirumala
• Nguyen FD
• Mehta A
• Schindler
• Mulukutla
• Jeevanantham V
• Wechsler L
• Gleason T

• KMID: 2392130
• DOI: http://doi.org/10.3988/jcn.2017.13.4.351

Abstract

BACKGROUND AND PURPOSE
Perioperative stroke is a significant complication of transcatheter aortic valve implantation (TAVI). This study aimed to quantify perioperative stroke as an independent risk factor for in-hospital mortality and postoperative morbidity in patients receiving TAVI.
METHODS
A retrospective cohort study was conducted using the National Inpatient Sample. Patients undergoing TAVI during 2012 and 2013 were identified using diagnostic codes of International Classification of Diseases, ninth revision. Univariate and multivariate analyses were performed using patient demographics and comorbidities to identify predictors of mortality and morbidity, defined by a length of stay of >14 days and/or discharge to a place other than home.
RESULTS
Data were obtained from 7,556 patients undergoing TAVI during 2012 and 2013. The incidence rates of mortality and morbidity were 4.57 and 71.12%, respectively. Perioperative stroke was an independent risk factor for mortality [odds ratio (OR)=3.182, 95% confidence interval (CI)=1.530-6.618, p=0.002], as were infection (OR=17.899, 95% CI=9.876-32.440, p<0.001) and pericardial tamponade (OR=7.272, 95% CI=2.874-18.402, p<0.001). Stroke also predicted morbidity (OR=5.223, 95% CI=2.005-13.608, p=0.001), which was also associated with age, being female, being Asian, moderate and high Van Walraven scores (VWR), and infection.
CONCLUSIONS
In conclusion, perioperative stroke was found to be independently associated with in-hospital mortality and postoperative morbidity, as are age and high VWR. Our findings support the use of further preoperative, intraoperative, and postoperative management strategies during TAVI.

Keyword

stroke; TAVI; mortality; morbidity

MeSH Terms

Asian Continental Ancestry Group
Cardiac Tamponade
Cohort Studies
Comorbidity
Demography
Female
Hospital Mortality*
Humans
Incidence
Inpatients
International Classification of Diseases
Length of Stay
Mortality
Multivariate Analysis
Retrospective Studies
Risk Factors
Stroke*
Transcatheter Aortic Valve Replacement*

Figure

• 

  Fig. 1 Proportion of overall mortality delineated by Elixhauser comorbidities. The most common Elixhauser comorbidities among the patients who died were hypertension, fluid and electrolyte disorders, and renal failure. RA: rheumatoid arthritis.

• 

  Fig. 2 Proportion of overall mortality delineated by non-Elixhauser comorbidities. The most common non-Elixhauser comorbidities among the patients who died were perioperative cardiac arrest, a previous cardiac intervention, and infection (e.g., sepsis or endocarditis). GI: gastrointestinal, ICD: International Classification of Diseases, MI: myocardial infarction.

• 

  Fig. 3 Significant comorbidities that predict mortality. Comorbidities that were significant predictors of in-hospital mortality. Previous cardiac intervention was negatively associated with mortality. CI: confidence interval, MI: myocardial infarction, OR: odds ratio, VWR: Van Walraven score.

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