What are the trends and outcomes of transcatheter aortic valve replacement (TAVR) in patients with myeloproliferative neoplasms compared to matched controls?

Myeloproliferative neoplasms (MPN) are clonal hematopoietic stem cell disorders that include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). These conditions are characterized by increased thrombotic and hemorrhagic risks, posing potential concerns for patients undergoing transcatheter aortic valve replacement (TAVR). However, comprehensive data regarding the safety and in-hospital outcomes of TAVR in patients with MPN remain limited.

We aimed to evaluate the in-hospital outcomes of TAVR among patients with MPN compared to those without MPN using a propensity score-matched cohort.

The National Inpatient Sample database from 2016 to 2022 was queried to identify all adult TAVR hospitalizations. Baseline characteristics, procedural outcomes, and in-hospital complications were compared between patients with and without MPN. Propensity score matching (PSM) was implemented to adjust for baseline differences between MPN and non-MPN groups. The primary outcome was in-hospital mortality. Secondary outcomes included stroke/transient ischemic attack, acute myocardial infarction, major bleeding, acute kidney injury, atrial fibrillation, pacemaker implantation, heart failure, length of stay, and total hospital charges.

Our study included 94,888 TAVR hospitalizations, with 262 (0.28%) patients having MPN. Following propensity score matching, 252 MPN patients were matched 1:1 with 250 non-MPN controls. Baseline characteristics were well-balanced after matching, with mean age 79.7±0.5 years in the MPN group versus 80.3±0.5 years in controls (p=0.344). In-hospital mortality rates were identical between groups (1.6% vs 1.6%, p=0.991). There were no significant differences in stroke/TIA (4.0% vs 3.6%, OR 0.81, 95% CI 0.26-2.53), acute myocardial infarction (2.0% vs 2.0%, OR 0.68, 95% CI 0.18-2.62), major bleeding (1.6% vs 2.4%, OR 0.72, 95% CI 0.17-3.05), acute kidney injury (12.7% vs 10.8%, OR 1.14, 95% CI 0.63-2.06), atrial fibrillation (38.9% vs 36.8%, OR 1.07, 95% CI 0.72-1.59), or pacemaker implantation (6.0% vs 6.4%, OR 0.97, 95% CI 0.49-1.95). Length of stay (difference +0.38 days, p=0.307) and total hospital charges (difference +$2,833, p=0.806) were also comparable between groups.

Our study demonstrated that patients with MPN undergoing TAVR had comparable in-hospital mortality and major complication rates compared to matched controls without MPN. These findings suggest that MPN should not be considered a contraindication to TAVR in appropriately selected patients. Further research is needed to evaluate long-term outcomes and identify optimal antithrombotic strategies in this population.