Rehospitalization rates after transcatheter aortic valve implantation.
OBJECTIVE
Comorbidities pose a major challenge to screening, selection and follow-up of transcatheter aortic valve implantation (TAVI) patients as well as to the procedure itself. The aim of the present study was to assess cardiac and non-cardiac readmission rates besides clinical endpoint data in the first 50 patients of a single center TAVI programme.


RESULTS
TAVI was performed using the transfemoral CoreValve system. Procedural success rate was 94%; intraprocedural mortality was 2%. 82% of the patients remained free of a combined safety endpoint at 30 days, and 76.1% remained free of a combined efficacy endpoint at six months (modified criteria of the Valve Academic Research Consortium). At six months, among all surviving patients, 10.3% had experienced readmissions for cardiac causes, and 43.6% had experienced readmissions for non-cardiac causes. Causes of non-cardiac readmissions showed a wide distribution over various medical disciplines, reflecting the high rate of comorbidities. Beyond six months until a predefined reference date (mean follow up 9.9 months), the probability of hospitalization fell by half (1.54 vs. 0.74 hospital days per patient per month), driven by a decrease of non-cardiac readmissions. Karnofsky score before and after TAVI yielded a significant and sustained improvement of performance status, as assessed retrospectively at reference date.


CONCLUSIONS
The findings of the present study suggest that the high prevalence of comorbidities in high-risk TAVI patients results in a high rate of non-cardiac rehospitalizations during the first 6 months of follow-up. Despite this fact, improvement of global everyday performance following TAVI as perceived by the patients seems to be substantial.
Department of Internal Medicine II, Cardiology, and Intensive Care Medicine, University Hospital Salzburg, Salzburg, Austria. m.hammerer@salk.at
Matthias
M
Hammerer
Jochen
J
Schuler
Johann
J
Altenberger
Johannes
J
Kraus
Erika
E
Prinz
Melinda
M
Matzinger
Maximilian
M
Pichler
Matthias
M
Heigert
D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D001317:Austria / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D011475:Prosthesis Failure; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome