Background: Conduction disturbances after transcatheter aortic valve replacement (TAVR) requiring permanent pacemaker (PPM) implantation are a well-known complication and are associated with worse long-term outcomes. Data on the effect of post-TAVR PPM implantation on 30-day readmission (30DR) rates is scarce.
Objective: To compare 30DR rates, length of stay (LOS), cost, and causes of readmission between patients who receive TAVR and those who receive TAVR and PPM and identify predictors of PPM implantation.
Methods: The Nationwide Readmissions Database (NRD) is a representative sample of all US hospitalizations, representing over 35 million discharges. The 2016 NRD was used to identify patients who underwent TAVR and PPM implantation from January-November 2016. Propensity matching was used to balance baseline clinical characteristics.
Results: Of the 44,607 patients who underwent TAVR, 4,878 (10.9%) required PPM implantation during their index hospitalization. Patients requiring PPM during their index admission for TAVR had a higher crude median LOS (5d vs. 3d, p<0.001), median cost ($61,604 vs. $45,513, p<0.001) and 30DR rate (14.5% vs 11.2%, p<0.001). After 2:1 propensity matching, PPM patients still had a higher median LOS (5d vs. 3d, p<0.001), median cost ($61,902 vs. $41,162, p<0.001), and 30DR rate (13.8% vs 11.1%, p=0.003). Patients who received PPM were more likely to be older (81.1 vs 80.3, OR 1.01, CI 1.01-1.02), diabetic (OR 1.27, 1.13-1.44), obese (OR 1.22, 1.05-1.43), and have right (OR 4.35, 3.72-5.09) or left (OR 1.80, 1.51-2.15) bundle branch blocks on multivariate analysis. Causes of readmission in patients with and without PPM were mainly non-cardiac (62.9% vs 68.0%). Heart failure was the most common cause of readmission for both groups (18.4% vs 14.6%). Median cost ($8716 vs $8250, p=0.34) and LOS (4d vs 4d, p=1) were not significantly different during readmissions.
Conclusion: Based on a nationally representative sample, 10.9% of patients undergoing TAVR required PPM implantation during the index hospitalization. Age, diabetes, obesity, and right or left bundle branch blocks were significant predictors of PPM implantation. PPM implantation resulted in significantly higher LOS, costs, and 30DRs on propensity-matched analysis.