Abstract Body (Do not enter title and authors here): Background
New-onset atrial fibrillation (AF) frequently occurs after cardiac procedures, such as transcatheter aortic valve replacement (TAVI) and surgical aortic valve replacement (SAVR), and is linked with significant morbidity and mortality. In the context of improving TAVI technology and physician expertise, we investigated the recent trends in procedure volume, in-hospital mortality, and atrial fibrillation associated with TAVI and SAVR.
Method
We conducted a retrospective study using the National Inpatient Sample (NIS) data from 2016 to 2020. We identified all TAVI and SAVR admissions using ICD-10 codes and compared the temporal trends in procedure volume, in-hospital mortality, and AF.
Results
A total of 296,275 TAVI and 298,300 SAVR were performed between 2016-2020. There was an increase in the annual volume of TAVI performed from 40,005 to 75,740 (p trend <0.01), along with a decrease in in-hospital mortality (1.85% to 1.19%, p trend <0.01) and new-onset AF (39.5% to 23.5%, p trend <0.01), this could be due to broadening of TAVI indications. For SAVR, there was a decrease in annual procedural volume (70,895 to 46,090, p trend <0.01) and associated new-onset AF (45.3% to 37.0%, p<0.01), but an increasing trend in in-hospital mortality (3.31% to 4.04%, p trend=0.03). AF was associated with 51% of TAVI and 77% of SAVR admissions. The predictors of AF included age, female sex, white race, chronic kidney disease, chronic lung disease, heart failure, coronary artery disease, diabetes mellitus, hypertension, chronic liver disease, obesity, smoking, and coagulopathy. In multivariate analysis, AF was not solely associated with in-hospital mortality after SAVR (aOR 0.78, 95% CI 0.65-0.79, p<0.01) or TAVI (aOR 1.1, 95% CI 0.94-1.29, p=0.24).
Conclusion
In this real-world study using contemporary data from NIS, we observed that annual TAVI numbers are increasing compared to SAVR, and associated AF and in-hospital mortality is decreasing. This is likely due to improved TAVI valves, techniques, and expertise in the field, as well as broadening TAVI indications to a relatively healthier AS patient population. In our analysis, AF did not predict in-hospital mortality for TAVI or SAVR.