The “Burden” of Transcatheter Aortic Valve Implantation Patients Admitted to the Intesive Coronary Care Unit

Background: Transcatheter aortic valve implantation (TAVI) is rapidly becoming the treatment of choice for high-surgical risk patients with symptomatic aortic stenosis. Little is known about the “burden” of TAVI patients admitted to the intensive coronary care unit (ICCU).

Methods: 2103 consecutive patients admitted to the Sheba Medical Center ICCU during 2014-2015 were enrolled. Patients were divided into those who underwent TAVI procedure or not.

Results: Of the 2013 patients, 159 (7.5%) were admitted post TAVI procedure. TAVI patients were older (80 ±7.86 vs. 64±14.9 years old, p<0.001) and comprised more of female gender [68(43%) vs. 506 (26%), p<0.001]. They suffered more from chronic obstructive pulmonary disease (COPD) [28 (18%) vs. 211 (11%), p=0.01], a history of malignancy [32 (20%) vs. 236 (12%), p=0.006], and anemia [30 (19%) vs. 174 (9%), p<0.001]. There was also a trend towards a history of elevated pulmonary hypertension and renal failure although it did not reach statistical significance [11 (7%) vs. 75 (4%), p=0.09 and 35 (22%) vs. 311 (16%), p=0.06, respectively]. Admission length was shorter in the TAVI group (2.5 ± 1.9 vs. 3.4 ± 3.7 days, p=0.001) although they had more permanent pacemaker implantations [31 (19%) vs. 159 (8%), p<0.001] and suffered more from major bleeding rates [17 (11%) vs. 54 (2%), p<0.001], blood transfusions [15 (9%) vs. 85 (4%), p=0.001] invasive hemodynamic monitoring [82 (52%) vs. 338 (17%), p=0.001] and cerebrovascular accident (CVA) [4 (2.5%) vs. 14 (0.7%), p<0.04]. Interestingly, mortality rate were similar between both groups [2 (1.5%) vs. 58 (3%), p=0.3] as were other complications such as infection, malignant arrhythmias and acute renal failure.

Conclusions: Patients admitted to the ICCU post TAVI procedure are older, have more co-morbidity and sustain more complicated in-hospital course. As such they present a heavy medical burden and challenge to the medical stuff.