Impact of Right Heart Failure on Outcomes of Transcatheter Aortic Valve Implantation: Insights from the National Inpatient Sample

Background: There are limited data on the impact of right heart failure (RHF) on patients undergoing transcatheter aortic valve implantation (TAVI). We investigated the mortality, in-hospital complications, length of stay, and total hospitalization charges for TAVI admissions, with and without RHF. Methods: We analyzed the National Inpatient Sample data from 2018 to 2022. The International Classification of Diseases-Tenth Revision (ICD-10) codes were used to define the patient cohorts. Propensity score weighting was used to balance patient demographic, hospital-level, and comorbidity data. Results: From 2018 to 2022, there were 383,860 TAVI admissions, among which 1915 (0.50%) had the presence of RHF. Compared to patients without RHF, mortality was higher in patients with RHF (7.57% vs. 1.11%, p < 0.01). Similarly, acute kidney injury (37.10% vs. 8.56%, p < 0.01), respiratory failure (12.79% vs. 1.91%, p < 0.01), and use of mechanical circulatory support (11.48% vs. 0.83%, p < 0.01) was higher in the cohort with RHF. Median length of stay (7 days vs. 2 days, p < 0.01) and hospitalization charges ($257,239 vs. $180,501, p < 0.01) were higher in patients with RHF. Conclusions: In conclusion, we report that RHF is associated with increased mortality risk, complications, and resource utilization in patients undergoing TAVI. Right ventricular function should be a part of the evaluation for TAVI, given significantly elevated risks associated with its presence.