Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review

Background Transcatheter aortic valve replacement (TAVR)/intervention has become the standard of care for treatment of severe aortic stenosis across the spectrum of risk. There are socioeconomic disparities in access to TAVR. The impact of these disparities on postprocedural outcomes remains unknown. Our objective was to examine the association between neighborhood‐level social deprivation and post‐TAVR mortality and hospital readmission. Methods and Results We conducted a population‐based retrospective cohort study of all 4145 patients in Ontario, Canada, who received TAVR from April 1, 2017, to March 31, 2020. Our co‐primary outcomes were 1‐year postprocedure mortality and 1‐year postprocedure readmission. Using Cox proportional hazards models for mortality and cause‐specific competing risk hazard models for readmission, we evaluated the relationship between neighborhood‐level measures of residential instability, material deprivation, and concentration of racial and ethnic groups with post‐TAVR outcomes. After multivariable adjustment, we found a statistically significant relationship between residential instability and postprocedural 1‐year mortality, ranging from a hazard ratio of 1.64 to a hazard ratio of 2.05. There was a significant association between the highest degree of residential instability and 1‐year readmission (hazard ratio, 1.23 [95% CI, 1.01–1.49]). There was no association between material deprivation and concentration of racial and ethnic groups with post‐TAVR outcomes. Conclusions Residential instability was associated with increased risk for post‐TAVR mortality, and the highest quintile of residential instability was associated with increased post‐TAVR readmission. To reduce health disparities and promote an equitable health care system, further research and policy interventions will be required to identify and support economically and socially minoritized patients undergoing TAVR.

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“…Moreover, these patients may have a higher burden of comorbidity, an independent risk factor for post‐TAVR readmission and mortality. 31 , 32 …”

Section: Discussionmentioning

confidence: 99%

Social Deprivation and Post‐TAVR Outcomes in Ontario, Canada: A Population‐Based Study

Patel

Ravindran

Qiu

et al. 2023

JAHA

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“…The spectrum of the detrimental macrophage reactions will depend on the implant characteristics as well as the status of the immune system (both local and systemic) of the patient. For example, implant integration in diabetic patients is significantly compromised by pro-inflammatory programming of innate immunity by metabolic factors (hyperglycemia, dyslipidemia) [ 131 , 132 , 133 , 134 , 135 ].…”

Section: Immune Response To Bioceramic Implantsmentioning

confidence: 99%

Interaction of Ceramic Implant Materials with Immune System

Rafikova

Piatnitskaia

Shapovalova

et al. 2023

IJMS

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The immuno-compatibility of implant materials is a key issue for both initial and long-term implant integration. Ceramic implants have several advantages that make them highly promising for long-term medical solutions. These beneficial characteristics include such things as the material availability, possibility to manufacture various shapes and surface structures, osteo-inductivity and osteo-conductivity, low level of corrosion and general biocompatibility. The immuno-compatibility of an implant essentially depends on the interaction with local resident immune cells and, first of all, macrophages. However, in the case of ceramics, these interactions are insufficiently understood and require intensive experimental examinations. Our review summarizes the state of the art in variants of ceramic implants: mechanical properties, different chemical modifications of the basic material, surface structures and modifications, implant shapes and porosity. We collected the available information about the interaction of ceramics with the immune system and highlighted the studies that reported ceramic-specific local or systemic effects on the immune system. We disclosed the gaps in knowledge and outlined the perspectives for the identification to ceramic-specific interactions with the immune system using advanced quantitative technologies. We discussed the approaches for ceramic implant modification and pointed out the need for data integration using mathematic modelling of the multiple ceramic implant characteristics and their contribution for long-term implant bio- and immuno-compatibility.

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Burden of hospitalization during the first year following transcatheter and surgical aortic valve replacement

Butt,

Yafasova,

Thein

et al. 2024

American Heart Journal

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Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review

Cited by 7 publications

References 63 publications

Social Deprivation and Post‐TAVR Outcomes in Ontario, Canada: A Population‐Based Study

Social Deprivation and Post‐TAVR Outcomes in Ontario, Canada: A Population‐Based Study

Interaction of Ceramic Implant Materials with Immune System

Burden of hospitalization during the first year following transcatheter and surgical aortic valve replacement

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