Association of hematological malignancies with clinical and financial outcomes following transcatheter aortic valve replacement

Liu, Zeyu; Aguayo, Esteban; Porter, Giselle; Ali, Konmal; Zinoviev, Radoslav; Benharash, Peyman

doi:10.1016/j.clinsp.2025.100741

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Original articles • Clinics 80 • 2025 • https://doi.org/10.1016/j.clinsp.2025.100741 linkcopy

Association of hematological malignancies with clinical and financial outcomes following transcatheter aortic valve replacement

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background While Transcatheter Aortic Valve Replacement (TAVR) is increasingly performed in patients with severe aortic stenosis, the impact of Hematologic Malignancies (HM) on associated outcomes, remains unclear. The authors The authors used a contemporary national database to investigate whether HM is associated with adverse clinical and financial outcomes following elective TAVR.

Materials and methods The authors The authors identified all adult (≥ 18-years) hospitalizations for elective TAVR in the 2016-2021 Nationwide Readmissions Database. Multivariable models were constructed to evaluate the association of HM with in-hospital mortality, major complications, non-home discharge, Length of Stay (LOS), index hospitalization costs, and 30-/90-day non-elective readmissions.

Results Of an estimated 336,998 TAVR procedures, 6123 (1.8 %) involved patients with HM. After risk adjustment, HM was not linked to in-hospital mortality (AOR = 0.96; 95 % CI 0.65-1.40; p = 0.82) or major complications, but conferred a modestly prolonged LOS (β+0.12 days; 95 % CI 0.01-0.25; p = 0.04) and increased costs (β+$1300; 95 % CI $400-$2300; p = 0.01). Moreover, HM was associated with higher odds of 30-day (AOR = 1.27; 95 % CI 1.13-1.42; p < 0.001) and 90-day (AOR = 1.33; 95 % CI 1.20-1.48; p < 0.001) non-elective readmissions. Notably, among 217 HM patients with a history of stem cell transplantation, in-hospital mortality risk was substantially elevated (AOR = 7.7; 95 % CI 1.53-38.8; p = 0.01).

Conclusion In conclusion, although HM did not adversely impact in-hospital mortality or major complications following TAVR, it was linked to modestly increased resource utilization and readmission. Patients with prior stem cell transplantation represent a particularly vulnerable subgroup, underscoring the need for multidisciplinary pre-operative evaluation and specialized perioperative care pathways.

Keywords
Hematological malignancies; Transcatheter aortic valve replacement; Nationwide readmissions database; Outcome

	Non‒HM (n = 331,875)	HM (n = 6123)	p-value
Age (median, IQR)	80 (74‒85)	80 (74‒85)	0.028
Female ( %)	44.2	36.1	<0.001
CORE Score (median, IQR)	37 (25‒48)	38 (27‒48)	<0.001
*Income Percentile ( %)*			<0.001
0‒25th	20.8	16.4
26‒50th	28.0	27.5
51‒75th	27.1	26.5
76‒100th	24.2	29.5
*Payer ( %)*			0.041
Private	6.9	8.2
Medicare	89.7	88.4
Medicaid	1.1	1
Other payer	2.3	2.4
*Comorbidity*
Congestive Heart Failure	63.2	64.9	0.062
Coronary Artery Disease	66.5	64.1	0.005
Peripheral Vascular Disease	21.1	19.2	0.013
Hypertension	89.7	86.7	<0.001
Chronic Pulmonary Disease	25.7	22	<0.001
Obesity	22	17.1	<0.001
Diabetes	37.5	31.8	<0.001
*Hospital Characteristics*
*Hospital Status ( %)*			0.33
Non-metropolitan	1.1	0.8
Metropolitan Non-teaching	10.7	10.4
Metropolitan Teaching	88.2	88.8
*Bed Size ( %)*			0.82
Large	72.3	72.4
Medium	22	21.6
Small	5.8	6

	Non-HM (n = 331,875)	HM (n = 6123)	p-value
In-Hospital Mortality ( %)	1.0	0.9	0.15
*Major Complications ( %)*	17.4	17.6	0.76
Vascular	10.3	10.5	0.75
Cardiac	4.9	4.8	0.90
Respiratory	3.9	3.9	0.87
Infectious	3.2	3.6	0.20
Neurologic/Stroke	1.8	1.7	0.50
Thromboembolic	0.4	0.6	0.14
*Resource Use*
LOS (days) (median [IQR])	2 [1‒3]	2 [1‒3]	0.11
Costs ($1000) (median [IQR])	45.0 [36.0‒58.0]	46.0 [36.0‒59.0]	<0.001
30-Day Non-Elective Readmission ( %)	8.9	10.9	<0.001
90-Day Non-Elective Readmission ( %)	11.8	15	<0.001
Non-Home Discharge ( %)	24.0	23.3	0.37

	HM (AOR/β, 95 % CI) (n = 6123)	p-value	C-Statistic / R²
In-Hospital Mortality	0.96 (0.65‒1.40)	0.82	0.82
*Major Complications*	0.99 (0.90‒1.10)	0.90	0.72
Vascular	1.01 (0.89‒1.14)	0.90	0.64
Cardiac	0.96 (0.81‒1.14)	0.64	0.65
Respiratory	1.01 (0.84‒1.22)	0.92	0.83
Infectious	1.24 (1.00‒1.55)	0.05	0.91
Neurologic/Stroke	0.93 (0.68‒1.25)	0.61	0.89
Thromboembolic	1.44 (0.86‒2.41)	0.17	0.70
*Resource Use*
LOS (days)	+0.12 (0.01‒0.25)	0.045	0.26
Costs ($1000)	+1.3 (0.4‒2.3)	0.004	0.09
30-Day Nonelective Readmission	1.27 (1.13‒1.42)	<0.001	0.60
90-Day Nonelective Readmission	1.33 (1.20‒1.48)	<0.001	0.60
Non-Home Discharge	0.99 (0.91‒1.1)	0.88	0.70

	History of Stem Cell Transplant (AOR/β, 95 % CI) (n = 217)	p-value	C-Statistic / R²
In-Hospital Mortality	7.70 (1.53‒38.8)	0.014	0.84
*Major Complications*	1.06 (0.62‒1.81)	0.84	0.71
Vascular	0.80 (0.40‒1.59)	0.52	0.65
Cardiac	0.83 (0.29‒2.37)	0.73	0.66
Respiratory	2.96 (1.31‒6.68)	0.009	0.81
Infectious	1.28 (0.31‒5.33)	0.73	0.91
Neurologic/Stroke	1.00 (0.31‒3.29)	0.99	0.92
Thromboembolic	0.51 (0.07‒3.69)	0.50	0.87
*Resource Use*
LOS (days)	+0.22 (−0.66‒+1.11)	0.62	0.28
Costs ($1000)	+4.5 (−1.4‒+10.5)	0.14	0.11
30-Day Nonelective Readmission	1.05 (0.57‒1.94)	0.88	0.60
90-Day Nonelective Readmission	1.10 (0.65‒1.88)	0.72	0.60
Non-Home Discharge	1.15 (0.68‒1.96)	0.61	0.70

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