In-hospital outcomes of elective TAVR complicated by cardiogenic shock: A Report from the National Inpatient Sample

Background:
Cardiogenic shock(CS) is an important complication after transcathter aortic valve replacement (TAVR) but has limited reported data. We sought to study the incidence, outcomes and management CS post TAVR.

Methods:
We queried the National Inpatient Sample from Jan 2012 to Sept 2015 for patients undergoing elective TAVR complicated by CS using appropriate ICD9 codes. Primary outcomes of interest was all-cause mortality with other outcomes as mentioned in Table 1. Procedure-related death was defined as death within 24-hours of TAVR. Multivariate logistic regression was done to evaluate for predictors of mortality.

Results:
Out of 51685, 430 patients (0.8%) developed CS post TAVR. Mean age was 80.9 years with 57% females. All-cause inpatient mortality was 31.4% with 25.9% of these patients having procedure-related death. There was a steady increase in incidence of CS from 11.6% in 2012 to 37.2% in 2015. Need for mechanical circulatory support (MCS) was 33.7%, with intraortic balloon pump being the most common device(72.4%). All other in-hospital complications are as shown in Table 1. Need for mechanical ventilation, development of multiorgan failure and need for MCS support were significant predictors of mortality in CS cohort.

Conclusions:
The development of CS post TAVR is relatively low with high inhospital mortality. About one-fourth of patients suffered procedure-related death, with respiratory failure being a significant predictor of overall mortality. Further research is warranted for better management of such patients.