Afify, Hesham

Background: There is a paucity of data regarding the temporal trends and outcomes of transcatheter aortic valve replacement (TAVR) among patients with prior coronary artery bypass graft (CABG) surgery. Methods: We queried the Nationwide Readmissions Database (2016-2019) for hospitalized patients who underwent TAVR using ICD-10 codes. We evaluated the trends and outcomes of TAVR among patients with versus without a history of prior CABG. Multivariable regression analysis was used to adjust for patients’ and hospitals' characteristics when comparing the study groups. The primary outcome was in-hospital mortality. Results: The final analysis included 173,274 admissions who underwent TAVR of whom 31,271 (18.3%) had a history of prior CABG. During the study years, there was a decrease in the proportion of patients with prior CABG among those undergoing TAVR (22.0% in 2016 vs. 16.2%, Ptrend=0.01), while there was no change in their in-hospital mortality rate (1.08% in 2016 vs. 1.25% in 2019, Ptrend= 0.43). Patients with prior CABG were younger and less likely to be women compared with those without prior CABG. On multivariable adjustment, In-hospital mortality was lower among the group with versus without prior CABG (adjusted odds ratio [aOR] 0.77; 95% confidence interval [CI] 0.65-0.91, p<0.01). Adjusted analysis showed lower rate of 90-day readmission (OR 0.95; 95%CI 0.90-0.98, p=0.01), and similar rate of ischemic stroke (aOR 0.89; 95%CI 0.76-1.03, p=0.89), permanent pacemaker (PPM) implantation (aOR 0.99; 95%CI 0.93-1.05, p=0.99). Among those with prior CABG, female gender, and chronic kidney disease ≥3 were independently associated with higher in-hospital mortality, and obesity was associated with lower in-hospital mortality. Conclusion: In this analysis, there was a decrease in the proportion of patients with prior CABG among those undergoing TAVR. TAVR among those with prior CABG was not associated with increased short-term mortality or PPM implantation.