Abstract 4364315: Clinical Outcomes of Transcatheter Aortic Valve Replacement in Adults with Congenital Heart Disease: A Nationwide Analysis

Background: As more patients with congenital heart disease (CHD) survive into adulthood, transcatheter aortic valve replacement (TAVR) is increasingly utilized in this complex population. However, adult CHD patients often present with complex anatomy, prior surgeries, and comorbidity profiles that challenge conventional risk stratification. Despite these factors, data on procedural outcomes remain limited. Methods: Using the National Inpatient Sample (2016–2022), we identified adult TAVR hospitalizations and stratified patients by CHD status into TAC (TAVR with CHD) and NCTA (TAVR without CHD). Survey-weighted multivariable logistic regression was used to assess associations with in-hospital outcomes, adjusting for age, sex, race, comorbidities, and hospital characteristics. The primary outcome was in-hospital mortality; secondary outcomes included cardiogenic shock (CS), arrhythmia (VA, AF), acute heart failure (AHF), acute kidney injury (AKI), aortic dissection, and healthcare utilization. Results: Of an estimated 472,495 TAVR hospitalizations, only 0.97% involved patients with CHD. Compared to NCTA, TAC patients were younger (mean age 76.1 vs. 78.5 years), more likely to be female (47.6% vs. 45.3%). TAC patients had higher odds of in-hospital mortality (3.1% vs. 1.2%; aOR 2.03, 95% CI 1.35–3.07; p =0.001), CS (4.8% vs. 1.9%; aOR 1.66, p =0.004), AF (42.9% vs. 37.4%; aOR 1.28, p =0.001), AHF (37.5% vs. 29.8%; aOR 1.21, p =0.012), AKI (15.5% vs. 9.2%; aOR 1.26, p =0.024), VA (6.4% vs. 3.6%; aOR 1.54, p =0.002), aortic dissection (6.4% vs. 3.7%; aOR 1.65, p =0.001), and vasopressor use (4.1% vs. 2.4%; aOR 1.45, p =0.03). Total hospital charges were significantly higher in the CHD group ($264,081 vs. $220,293; p <0.001), while length of stay did not differ significantly (5 vs. 4 days; p =0.82). No differences were observed in cardiac arrest, mechanical circulatory support, stroke, or pacemaker implantation. Conclusion: CHD patients undergoing TAVR represent a small yet high-risk population, with significantly greater odds of in-hospital complications and increased healthcare costs. These findings emphasize the need for specialized structural heart expertise and prospective studies to guide tailored strategies and improve outcomes in this population.