In-Hospital Outcomes of Transcatheter Aortic Valve Replacement with Hyponatremia - A Propensity Matched Analysis.
Presenter
Mohamed Zghouzi, MD, The University of Michigan, Dearborn Heights, MI
Mohamed Zghouzi, MD1, Waqas Ullah, M.D.2, Munnam Jafar, MD2, Salman Zahid3, Yasar Sattar, MD4, Nathan Zaher, MD5, Yasser Al-khadra, M.D.6, Fahed Darmoch, M.D.7, Homam Moussa Pacha, M.D8, Bachar Ahmad5, Rodrigo Bagur, M.D., Ph.D., FSCAI9, Mohamed Mohamed10, Rajiv Tayal, M.D., FSCAI11, David Lee Fischman, M.D., FSCAI12, Samir Ramesh Kapadia, M.D., FSCAI13, David G. Rizik, M.D., MSCAI14, Kenton Zehr, MD5, Mamas A. Mamas, M.D., FRCP, FSCAI15 and M Chadi Alraies, MD, FSCAI16, (1)The University of Michigan, Dearborn Heights, MI, (2)Abington Jefferson Health, Abington, PA, (3)Rochester General Hospital, Rochester, NY, (4)Icahn School of Medicine at Mount Sinai Elmhurst, Elmhurst, NY, (5)Detroit Medical Center Heart Hospital, Detroit, MI, (6)The Cleveland Clinic Foundation, Cleveland, OH, (7)St. Vincent Charity Medical Center, cleveland, OH, (8)University of Texas Health Science Center, McGovern Medical School, Memorial Hermann Heart & Vascular Institute, Houston, TX, (9)London Health Sciences Centre, London, ON, Canada, (10)National Institute for Health Research (NIHR), Leeds, United Kingdom, (11)The Valley Hospital, Ridgewood NJ, Warren, NJ, (12)Thomas Jefferson University Hospital, Philadelphia, PA, (13)Cleveland Clinic Main Campus, CHAGRIN FALLS, OH, (14)HonorHealth Heart Group, Scottsdale, AZ, (15)Keele University, Stoke-on-Trent, Staffordshire, United Kingdom, (16)Detroit Medical Center Heart Hospital, Bloomfield , MI
Keywords: Complications, Structural Heart Disease (SHD) and TAVI/TAVR/Aortic Valve
Background
Hyponatremia is highly prevalent among hospitalized patients and is associated with increased mortality. The impact of periprocedural hyponatremia on in-hospital outcomes after transcatheter aortic valve replacement (TAVR) is unknown. Methods
All TAVR procedures between 2002 to 2017 in the National Inpatient Sample were analyzed, stratified by the presence or absence of periprocedural hyponatremia. Propensity score matching was used to obtain adjusted odds ratio (aOR), accounting for baseline differences between the two groups. Results
A total of 161,029 patients underwent TAVR, including 152,452 (94.7%) with no hyponatremia and 8577 (5.3%) with hyponatremia. A propensity-matched analysis of 5,655 (2768 without hyponatremia, 2887 with hyponatremia) revealed no significant differences between the two cohorts in terms of demographics and baseline comorbidities. The adjusted odds for in-hospital mortality (aOR 1.65, 95% CI 1.26-2.15, P=<0.001) and cardiopulmonary arrest (aOR 3.11, 95% CI 2.18-4.44, P=<0.001) were significantly higher for TAVR patients with concomitant hyponatremia. Similarly, LOS (12.40±9.47 vs. 9.46± 6.95 days, p=<0.001), total charges per hospitalization ($270886.24±175138.94 vs. $201485.50±118022.61, P=<0.001), and procedures on record (6.30 ±3.90 vs. 5.67 ±3.32, P= <0.001) were higher in the patients with hyponatremia compared with the control group. Conclusions
Patients with TAVR who have periprocedural hyponatremia are at greater odds of adverse outcomes than patients with normal sodium levels. 