In-Hospital Outcomes in Patients with a History of Malignancy Undergoing Transcatheter Aortic Valve Implantation.

A history of malignancy is incorporated in the Society of Thoracic Surgeons score to assess presurgical risk in patients undergoing surgical aortic valve replacement, however data on the prognostic importance in those undergoing transcatheter aortic valve implantation (TAVI) remains limited. We sought to investigate the utilization and in-hospital outcomes of TAVI in patients with a history of malignancy. The National Inpatient Sample Database was queried from 2012 to 2017 to identify patients who underwent TAVI using International Classification of Diseases (ICD) 9 and ICD-10 procedure codes. Between 2012 and 2017, there were 123,070 patients who underwent TAVI, of these 23,670 patients (19.2%) had a prior history of malignancy. The proportion of patients undergoing TAVI with a history of malignancy trended upward between 2012 to 2017. Patients with a history of malignancy were similar in age to those without (81.1±7.9 vs. 80.1±6.7 years old, p<0.001), with a higher prevalence of tobacco use and major depressive disorder (p<0.001 for both). Patients with a history of malignancy had higher rates of post-TAVI pacemaker implantation (p<0.001), otherwise periprocedural complication rates were similar to those without. Using a multivariate logistic regression model to adjust for confounding factors, a history of malignancy was predictive of decreased odds of death in patients undergoing TAVI (OR: 0.67, 95% CI; 0.60 to 0.76, p<0.001) and higher odds of pacemaker implantation (OR: 1.14, 95% CI; 1.09 to 1.19, p<0.001). In conclusion, with time the proportion of TAVI patients with a history of malignancy trended upward. Despite a greater prevalence of prior tobacco use and major depressive disorder, patients with a history of malignancy had TAVI safely with a low in-hospital all-cause mortality, yet greater cost of hospitalization and more frequent implantation of pacemaker devices.