Abstract
Background
Early rehospitalisation after transcatheter aortic valve implantation (TAVI) is frequently required but data regarding its prevalence, aetiology, predictors and prognostic relevance are limited.
Methods
We retrospectively analysed consecutive patients undergoing TAVI between August 2012 and October 2025. Early rehospitalisation was defined as any admission within 30 days from the index hospitalisation. Data regarding rehospitalisation causes, predictors, outcomes and impact on mortality were collected. Associations were evaluated using univariable and multivariable logistic and Cox regression models and Kaplan-Meier curve analyses.
Results
A total of 1347 patients (43.8% women, mean age 81±6 years) were included. Early rehospitalisation was required in 131 (9.7%), most frequently due to infection (22.9%), heart failure (HF 19.8%) and bradycardia (9.9%). Independent predictors of rehospitalisation for infection were chronic HF (OR 2.60, 95% CI 1.02 to 6.59; p=0.045), chronic obstructive pulmonary disease (OR 3.18, 95% CI 1.27 to 7.96; p=0.013) and contrast dye volume (OR 1.25 per 25 mL increase, 95% CI 1.09 to 1.44; p=0.002). Rehospitalisation for decompensated HF was significantly associated with chronic HF (OR 3.82, 95% CI 1.24 to 11.81; p=0.020), paravalvular leak ≥mild (OR 5.05, 95% CI 1.50 to 16.98; p=0.009) and reduced postprocedural ejection fraction (OR 3.85, 95% CI 1.20 to 12.50; p=0.022). Conduction abnormalities at discharge predicted rehospitalisation for bradycardia requiring pacemaker implantation (OR 4.65, 95% CI 1.39 to 15.57; p=0.013). Early (≤2 days) discharge was not associated with an increased risk of rehospitalisation (27.7% vs 20.3%, p=0.073). 1-year all-cause mortality was higher for the early rehospitalisation group after multivariable adjustment (HR 3.03, 95% CI 1.90 to 4.86; p<0.001).
Conclusions
Nearly one-tenth of patients were readmitted after index hospitalisation. The most prevalent causes were infection, HF and bradycardia. Modifiable risk factors were contrast dye volume, ≥mild paravalvular leaks and discharge conduction abnormalities. Early discharge did not predict rehospitalisation. Mortality risk at 1 year was three times higher in patients requiring early rehospitalisation.
Keywords: Transcatheter Aortic Valve Replacement, Aortic Valve Stenosis, RISK FACTORS
WHAT IS ALREADY KNOWN ON THIS TOPIC
Rehospitalisation after transcatheter aortic valve implantation (TAVI) is relatively common; however, data regarding its prevalence, predictors and prognostic relevance are not clearly defined.
WHAT THIS STUDY ADDS
About 1 in 10 patients was rehospitalised within 30 days after TAVI discharge. Modifiable predictors included lack of procedural success, paravalvular regurgitation, discharge conduction disturbances and contrast dye volume, while early discharge did not increase 30-day rehospitalisation risk.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
Early rehospitalisation confers a threefold increased risk of subsequent 1-year mortality, underscoring the need for close clinical monitoring of these patients.
Introduction
Aortic stenosis represents the most prevalent valvular heart disease in the developed world. Indeed, the severe form has a yearly incidence rate of approximately 0.5% among individuals aged ≥65 years,1 and accounts for the highest mortality among valvular heart disease-related deaths.2 Transcatheter aortic valve implantation (TAVI) is increasingly performed for the treatment of severe aortic stenosis. The recent European guidelines lowered the age threshold for considering TAVI to 70 years, irrespective of surgical risk.3 Consequently, with expanding indications, procedure volumes are expected to further increase globally.
In parallel, available valve platforms and implantation techniques continue to evolve, leading to substantial improvements in procedural safety, duration of hospitalisation and both early and long-term clinical outcomes. Despite these advances, post-TAVI rehospitalisation remains a concern, with 30-day rehospitalisation rates ranging from 3.5 to 22.4% in previous studies4,6 due to both cardiovascular (CV) and non-CV causes.6 7 Rehospitalisations are an important quality healthcare metric, both in terms of patient prognosis, quality of life and economic sustainability,8 and are therefore a common clinical endpoint in structural heart intervention trials. In an effort to optimise TAVI interventions and identify those patients at risk for undesirable outcomes, the aim of our study was to further report on the incidence, predictors and prognostic value of these early rehospitalisations in a large, real-world, all-comer population.
Methods
Study cohort
This retrospective study included all consecutive patients with severe aortic stenosis who underwent TAVI at a single, high-volume tertiary referral centre in Switzerland between August 2012 and October 2025. Patient data including baseline, procedural, in-hospital and discharge characteristics were collected from electronic medical records. Clinical outcomes were defined according to the Valve Academic Research Consortium-3 criteria.9 All patients were discussed in the interdisciplinary heart team meeting. It was not appropriate or possible to involve patients or the public in the design, or conduct, or reporting, or dissemination plans of our research. Exclusion criteria comprised valve-in-valve procedures, intervention for isolated aortic regurgitation, mortality during index hospitalisation and available postdischarge follow-up of shorter than 30 days (figure 1).
Figure 1. Patient selection and study design. Patient eligibility assessment and exclusion criteria. Study timeline with index TAVI discharge, rehospitalisation within 30 days and 1-year survival status assessment. TAVI, transcatheter aortic valve implantation.
Hospitalisation
Index hospitalisation was defined as the hospitalisation during which the TAVI procedure was performed, encompassing the postprocedural hospital stay, including cases of direct transfer to another hospital or department, until discharge at home or to a rehabilitation facility. Early rehospitalisation was defined as any urgent or elective hospital admission lasting more than 24 hours and occurring within 30 days after discharge from the index hospitalisation. Follow-up for rehospitalisation was censored at 30 days or at death, whichever occurred first. Rehospitalisation days were calculated from the day of index hospitalisation discharge until the first day of rehospitalisation. Rehospitalisation causes were grouped into CV and non-CV. A detailed list of rehospitalisation causes and corresponding International Classification of Diseases, Tenth Edition is provided in the online supplemental tables S1, S2. For rehospitalisations, information on length of stay, primary intervention, intensive care unit admission, in-hospital mortality and discharge destination were collected.
Mortality
Survival status was assessed through 31 October 2025. Follow-up for mortality was censored at 1 year or at death, whichever occurred first.
Statistical analysis
Categorical variables are presented as absolute numbers and percentages; continuous variables are expressed as mean±SD or median with IQR, as appropriate based on their distribution. Categorical variables were compared using the χ² test. Continuous variables with normal distribution were compared using the student’s t-test, whereas the Wilcoxon rank-sum test was used for non-normally distributed variables. Cases with missing data were excluded from the corresponding analyses. To identify independent predictors of early rehospitalisation, multivariable logistic regression analysis was performed. Results are reported as ORs with corresponding 95% CIs. Survival and rehospitalisation rates were assessed using Kaplan-Meier (KM) curves and compared with the log-rank test as well as multivariable Cox regression analysis. Results are reported as HRs with corresponding 95% CIs. A two-sided p value <0.05 was considered statistically significant. Statistical analyses were performed using Stata V.19 (StataCorp LLC, College Station, Texas, USA).
Results
Baseline and in-hospital characteristics
The study included 1347 patients, with a mean age of 81±6 years, of whom 591 (43.8%) were women. The median length of hospital stay was 5 days (IQR 2–9) and 362 (27.0%) patients were discharged early (≤2 days). Baseline characteristics of the overall population are summarised in table 1, while procedural and in-hospital characteristics are summarised in table 2. Baseline, procedural and in-hospital characteristics of the rehospitalisation subgroups are presented in online supplemental tables S3–S5.
Table 1. Baseline characteristics.
| Variable | All patients (n=1347) |
No early rehosp. (n=1216) |
Early rehosp. (n=131) |
P value |
|---|---|---|---|---|
| Demographics | ||||
| Age, years | 81.4±6.2 | 81.3±6.1 | 81.7±6.7 | 0.479 |
| Female sex | 591 (43.9) | 536 (44.1) | 55 (42.0) | 0.646 |
| BMI, kg/m² | 27.2±6.4 | 27.2±6.5 | 27.1±5.2 | 0.828 |
| Clinical history | ||||
| Hypertension | 1050 (78.0) | 939 (77.2) | 111 (84.7) | 0.049 |
| Diabetes mellitus | 329 (24.4) | 291 (23.9) | 38 (29.0) | 0.199 |
| Coronary artery disease | 700 (52.2) | 627 (51.8) | 73 (56.2) | 0.342 |
| Previous myocardial infarction | 141 (10.5) | 131 (10.8) | 10 (7.6) | 0.265 |
| Previous PCI | 286 (21.3) | 260 (21.4) | 26 (19.9) | 0.680 |
| Previous CABG | 85 (6.3) | 77 (6.3) | 8 (6.1) | 0.920 |
| COPD | 164 (12.2) | 145 (11.9) | 19 (14.5) | 0.391 |
| Atrial fibrillation | 366 (27.2) | 318 (26.2) | 48 (36.6) | 0.010 |
| Congestive heart failure | 319 (23.9) | 272 (22.6) | 47 (36.2) | 0.001 |
| Bicuspid valve | 74 (5.5) | 70 (5.8) | 4 (3.1) | 0.197 |
| CIED | 128 (9.5) | 117 (9.6) | 11 (8.4) | 0.650 |
| Electrocardiography | ||||
| QRS duration, ms | 96 (86–120) | 96 (86–120) | 100 (88–132) | 0.061 |
| Baseline conduction disturbances | 0.415 | |||
| RBBB | 124 (9.2) | 107 (8.8) | 17 (13.0) | |
| LBBB | 102 (7.6) | 92 (7.6) | 10 (7.6) | |
| AV block | 13 (1.0) | 12 (1.0) | 1 (0.8) | |
| Any conduction disturbance | 239/1246 (19.2) | 211/1127 (18.7) | 28/119 (23.5) | 0.205 |
| Paced rhythm | 101 (7.5) | 89 (7.3) | 12 (9.2) | 0.447 |
| Echocardiography | ||||
| LVEF category | 0.932 | |||
| EF ≤30% | 84 (6.2) | 76 (6.3) | 8 (6.1) | |
| EF 31–50% | 261 (19.4) | 234 (19.2) | 27 (20.6) | |
| EF >50% | 1002 (74.4) | 906 (74.5) | 96 (73.3) | |
| Mean gradient, mm Hg | 45.3±14.9 | 45.5±15.0 | 43.3±14.8 | 0.108 |
| Laboratory values | ||||
| Haemoglobin, g/dL | 126±19 | 127±18 | 122±20 | 0.004 |
| Renal function | 0.358 | |||
| eGFR >60 mL/min/1.73 m² | 541 (40.2) | 496 (40.8) | 45 (34.4) | |
| eGFR 30–60 mL/min/1.73 m² | 669 (49.7) | 598 (49.2) | 71 (54.2) | |
| eGFR <30 mL/min/1.73 m² | 137 (10.2) | 122 (10.0) | 15 (11.5) |
Values are median (IQR), N (%) or mean±SD
Bold entries are statistically significant differences.
AV, atrioventricular; BMI, body mass index; CABG, coronary artery bypass grafting; CIED, cardiac implantable electronic device; COPD, chronic obstructive pulmonary disease; EF, ejection fraction; eGFR, estimated glomerular filtration rate; LBBB, left bundle branch block; LVEF, left ventricular ejection fraction; PCI, percutaneous coronary intervention; RBBB, right bundle branch block; rehosp., rehospitalisation.
Table 2. In-hospital characteristics.
| Variable | Overall (n=1347) |
No early rehosp. (n=1216) |
Early rehosp. (n=131) |
P value |
|---|---|---|---|---|
| Procedure characteristics | ||||
| Elective procedure | 1160 (86.1) | 1052 (86.5) | 108 (82.4) | 0.200 |
| Transfemoral access | 1288 (95.6) | 1164 (95.7) | 124 (94.7) | 0.571 |
| Valve expansion mechanism | 0.451 | |||
| Balloon-expandable valve | 319 (25.2) | 291 (25.5) | 28 (22.4) | |
| Self-expanding valve | 948 (74.8) | 851 (74.5) | 97 (77.6) | |
| Cerebral protection device | 632 (47.0) | 569 (46.9) | 63 (48.5) | 0.730 |
| Predilatation | 980 (79.7) | 886 (80.2) | 94 (75.8) | 0.250 |
| Postdilatation | 245 (18.3) | 218 (18.0) | 27 (20.8) | 0.440 |
| Procedure duration, min | 45 (36–58) | 45 (36–58) | 46 (35–61) | 0.574 |
| Contrast volume, mL | 103 (85–137) | 102.5 (85–135) | 108.5 (88–150) | 0.108 |
| Concomitant intervention | ||||
| Any | 185 (13.7) | 166 (13.7) | 19 (14.5) | 0.788 |
| PCI | 137 (10.2) | 125 (10.3) | 12 (9.2) | 0.687 |
| Prosthesis–patient mismatch | 124 (12.7) | 116 (13.1) | 8 (8.8) | 0.211 |
| Lack of technical success | 89 (6.6) | 69 (5.7) | 20 (15.2) | <0.001 |
| In-hospital complications | ||||
| Vascular complication | ||||
| Any | 112 (8.3) | 95 (7.8) | 17 (13.0) | 0.042 |
| Major | 67 (5.0) | 57 (4.7) | 10 (7.6) | 0.141 |
| Major/life-threatening bleeding | 74 (5.5) | 67 (5.5) | 7 (5.3) | 0.937 |
| Ischaemic stroke/TIA | 32 (2.4) | 27 (2.2) | 5 (3.8) | 0.254 |
| Infection | 15 (1.1) | 13 (1.1) | 2 (1.5) | 0.635 |
| New pacemaker implantation | 101 (7.5) | 92 (7.6) | 9 (6.9) | 0.774 |
| Any complication | 247 (18.3) | 214 (17.6) | 33 (25.2) | 0.033 |
| Postprocedural echocardiography | ||||
| LVEF category | 0.153 | |||
| EF ≤30% | 46 (3.4) | 38 (3.1) | 8 (6.1) | |
| EF 31–50% | 242 (18.0) | 216 (17.8) | 26 (19.9) | |
| EF >50% | 1059 (78.6) | 962 (79.1) | 97 (74.0) | |
| Mean gradient, mm Hg | 7.6±4.3 | 7.7±4.3 | 7.1±4.1 | 0.125 |
| PASP, mm Hg | 36 (30–44) | 36 (30–44) | 39 (33–43) | 0.543 |
| LVEDD, mm | 46.0±7.1 | 45.9±7.0 | 47.1±8.1 | 0.104 |
| ≥Mild paravalvular leak | 559 (42.2) | 495 (41.3) | 64 (50.8) | 0.027 |
| Electrocardiography | ||||
| Discharge conduction disturbances | 0.967 | |||
| RBBB | 65 (5.6) | 57 (5.5) | 8 (6.7) | |
| LBBB | 227 (19.5) | 204 (19.6) | 23 (19.2) | |
| AV block | 10 (0.9) | 9 (0.9) | 1 (0.8) | |
| Any conduction disturbance | 302 (30.5) | 270 (30.5) | 32 (30.8) | 0.951 |
| Paced rhythm | 173 (14.9) | 157 (15.1) | 16 (13.3) | 0.616 |
| Hospital course | ||||
| Early discharge ≤2 days | 362 (27.0) | 336 (27.7) | 26 (20.3) | 0.073 |
Values are median (IQR), N (%) or mean±SD.
Bold entries are statistically significant differences.
AV, atrioventricular; EF, ejection fraction; LBBB, left bundle branch block; LVEDD, left ventricular end-diastolic diameter; LVEF, left ventricular ejection fraction; PASP, pulmonary artery systolic pressure; PCI, percutaneous coronary intervention; RBBB, right bundle branch block; rehosp., rehospitalisation; TIA, transient ischaemic attack.
Incidence and causes of early rehospitalisation
Rehospitalisation within 30 days was required in 131 (9.7%) patients. Of these, 72 (55.0%) were due to CV causes, most commonly heart failure (HF, n=26, 19.8%) and arrhythmias (n=19, 14.5%). Among arrhythmic events, bradycardias requiring permanent pacemaker (PPM) implantation accounted for 13 (9.9%) cases, including 11 episodes of high-degree atrioventricular block, whereas tachyarrhythmias accounted for 7 (4.6%) cases. The remaining 59 rehospitalisations (45.0%) were due to non-CV causes, mainly infections (n=30, 22.9%), most commonly respiratory (n=7, 23.3%) and urinary tract (n=6, 20%) among all. Infective endocarditis accounted for three cases (2.3%). Median time to rehospitalisation was 14 days (IQR 5–22). KM curves depicting all-cause, CV and non-CV rehospitalisation events over time are shown in online supplemental central illustration. There were no significant differences in early rehospitalisation rates across TAVI eras (2012–2016, 2017–2021 and 2022–2025; p=0.5). A detailed subanalysis of rehospitalisation rates and causes across temporal eras is provided in the online supplemental tables S6, S7.
Predictors of early rehospitalisation
In multivariable analysis, independent predictors of all-cause early rehospitalisations were pre-existing HF, lower haemoglobin levels, paravalvular leak ≥mild and lack of procedural technical success. Early (≤2 days) discharge was not a significant predictor of rehospitalisation (table 3). Significant predictors of early infection rehospitalisation were chronic HF, chronic obstructive pulmonary disease and contrast dye volume. Predictors of HF rehospitalisation were chronic HF, ≥mild postprocedural paravalvular leak and reduced postprocedural left ventricular ejection fraction (LVEF). Patients with conduction abnormalities at discharge had a significantly increased risk of rehospitalisation for bradycardia requiring PPM implantation, as shown in table 4. A detailed subanalysis of all-cause rehospitalisation predictors across temporal TAVI eras is provided in online supplemental table S8.
Table 3. Multivariable logistic regression—all-cause rehospitalisation.
| Variable | OR | 95% CI | P value |
|---|---|---|---|
| Hypertension | 1.45 | 0.87 to 2.40 | 0.152 |
| Atrial fibrillation | 1.40 | 0.94 to 2.08 | 0.098 |
| Congestive heart failure | 1.70 | 1.13 to 2.56 | 0.010 |
| Low haemoglobin | 1.12 | 1.01 to 1.24 | 0.029 |
| Paravalvular leak ≥mild | 1.46 | 1.00 to 2.12 | 0.047 |
| Lack of technical success | 3.21 | 1.66 to 6.18 | 0.001 |
Bold entries are statistically significant differences.
Table 4. Multivariable logistic regression—subgroup rehospitalisation.
| Variable | OR | 95% CI | P value |
|---|---|---|---|
| Infection hospitalisations | |||
| COPD | 3.18 | 1.27 to 7.96 | 0.013 |
| Congestive heart failure | 2.60 | 1.02 to 6.59 | 0.045 |
| Atrial fibrillation | 2.25 | 0.95 to 5.31 | 0.065 |
| Contrast volume (per 25 mL) | 1.25 | 1.09 to 1.44 | 0.002 |
| Baseline mean gradient (per mm Hg) | 0.98 | 0.95 to 1.01 | 0.299 |
| Elective procedure | 0.38 | 0.14 to 1.03 | 0.056 |
| Self-expanding valve | 0.47 | 0.19 to 1.14 | 0.095 |
| Heart failure hospitalisations | |||
| Congestive heart failure | 3.82 | 1.24 to 11.81 | 0.020 |
| Any baseline conduction disturbance | 2.69 | 0.86 to 8.40 | 0.089 |
| Atrial fibrillation | 1.97 | 0.67 to 5.74 | 0.216 |
| Reduced postprocedural LVEF | 3.85 | 1.20 to 12.50 | 0.022 |
| ≥Mild paravalvular leak | 5.05 | 1.50 to 16.98 | 0.009 |
| Procedure duration (per min) | 1.01 | 1.00 to 1.02 | 0.172 |
| Lack of technical success | 1.54 | 0.24 to 10.05 | 0.649 |
| Bradycardia hospitalisations (univariate) | |||
| Any discharge conduction disturbance | 4.65 | 1.39 to 15.57 | 0.013 |
Bold entries are statistically significant differences.
COPD, chronic obstructive pulmonary disease; LVEF, left ventricular ejection fraction.
Early rehospitalisation outcomes
The median length of hospital stay was 5 days (IQR 3–11). Among all rehospitalisations, four patients (3.1%) died during the hospitalisation period. 49 (38.6%) patients required an invasive intervention, most frequently PPM implantation (n=13, 10.2%). Two patients (0.02%) required reintervention at the prosthesis level.
1-year mortality predictors
Cumulative 1-year all-cause mortality was 21.4% (n=28) in patients requiring early rehospitalisation versus 6.4% (n=78) in the non-hospitalised subgroup (p<0.001, figure 2). The association remained statistically significant after multivariable adjustment for potential confounders (HR 3.03, 95% CI 1.90 to 4.86; p<0.001) (online supplemental tables S9, S10). Among rehospitalisation characteristics, the need for intensive care unit admission during rehospitalisation (HR 1.46, 95% CI 1.12 to 1.90; p=0.005) and length of hospital stay (HR 1.07 per day, 95% CI 1.01 to 1.13; p=0.017) were independently associated with higher 1 year all-cause mortality (online supplemental table S11).
Figure 2. All-cause mortality according to early rehospitalisation status. Kaplan-Meier curves for cumulative all-cause mortality stratified by early rehospitalisation within 30 days after discharge, log-rank p<0.001.
Discussion
The main findings are as follows: (1) nearly 1 in 10 patients was readmitted to the hospital within 30 days after discharge; (2) potentially modifiable factors associated with early rehospitalisation included lack of procedural success, paravalvular regurgitation, discharge conduction disturbances and contrast dye volume; (3) early (≤2 days) discharge was not associated with an increased risk of early rehospitalisation; and (4) early rehospitalisation was associated with a threefold increase in 1-year all-cause mortality risk.
Rehospitalisation rates and causes
The early rehospitalisation rate observed in our study was relatively lower than that reported in the literature,4 5 7 10 11 despite the inclusion of both urgent and elective rehospitalisations. The rehospitalisation rate was low, even though the study included patients treated from 2012 onwards. Of note, there were no significant differences in early rehospitalisation rates across the years. Causes of rehospitalisation were almost evenly distributed between CV and non-CV, in contrast to previous studies that report a slightly lower proportion of CV aetiologies.6 7 12 HF and arrhythmias represent the first and second most common CV cause of rehospitalisation, respectively.4 7 12 Of note, although embolic stroke remains a major concern, mainly within the first 30 days after the procedure,13 all-cause stroke accounted for 1% of rehospitalisations in our cohort.
All-cause rehospitalisation predictors
To the best of our knowledge, this is the first study to identify anaemia as a risk factor for early rehospitalisation. This is in line with two previous studies, which showed lower preoperative haemoglobin to be predictive of late (≥30 day)14 and 90-day15 rehospitalisation. Although procedure urgency is reported as a risk factor,16 we did not confirm such a finding. Lack of technical success has been associated with a higher risk of 30-day CV death and stroke.17 We showed here a threefold increase in the risk of early rehospitalisation in case of technical failure. As expected, procedural performance plays a significant role in short-term outcomes as well; thus, optimising delivery systems and prioritising safety is of utmost importance to minimise adverse outcomes.
Infection rehospitalisation
Pneumonia has been previously described as the most prevalent reason for early TAVI rehospitalisation.7 10 We also found respiratory-related infections to be the most common non-CV cause, followed by urinary tract infection, highlighting a potential target for preventive strategies. Apart from the burden of baseline comorbidities and patient vulnerability, the high infection rate may partly reflect an underlying inflammatory burden following TAVI, rather than procedural characteristics per se. A higher susceptibility of long-term infection-related hospitalisation appears to persist as well, despite favourable valve-related outcomes.18
HF rehospitalisation
Predictors of HF decompensation in chronic HF are well documented.19 However, it is unclear whether the same applies to TAVI patients, considering the distinct underlying cardiac remodelling patterns.20 From a pathophysiological perspective, increased HF hospitalisations after TAVI may be attributed to the persistence of ventricular hypertrophy and fibrosis, diastolic and microvascular dysfunction, and pulmonary hypertension.21 Importantly, HF in patients undergoing TAVI is not caused by the obstruction alone, so the residual myocardial and vascular abnormalities continue to pose a rehospitalisation risk.
Early improvement in LVEF after TAVI is a marker of the myocardial reserve potential and ventricular adaptation following afterload reduction.21 The absence of such systolic recovery in the early postinterventional period may predispose patients to elevated filling pressures, providing a plausible mechanistic explanation for the increased risk of HF rehospitalisation observed in our study. In addition to ventricular dysfunction, valvular performance can also exacerbate adverse outcomes. The undesirable effects of a moderate or severe post-TAVI paravalvular leak are well-documented.22 Its presence induces acute aortic regurgitation, volume and pressure overload23 that can eventually lead to left ventricular remodelling.24 These haemodynamic changes, however, can from early on contribute to an increased mechanical burden, and therefore increase HF decompensation risk.
Bradycardia rehospitalisation
High degree AV-block rehospitalisation suggests the extension of the bradycardia burden beyond the periprocedural period. Of note, new PPM implantation at index hospitalisation was not protective for a new bradycardia hospitalisation. Abnormal discharge electrocardiographic findings may therefore serve as a marker for closer postdischarge surveillance, allowing prompt detection of clinically significant conduction deterioration, especially in patients who develop conduction disturbances after the procedure.25
Length of stay
Length of hospital stay after TAVI has dropped dramatically in recent years, while several studies have demonstrated the safety of next-day discharge strategies.1026,29 A short length of stay was not associated with early rehospitalisation in our cohort. Nevertheless, additional studies with longer follow-up are warranted to confirm whether these favourable short-term outcomes translate into comparable long-term clinical results.
Rehospitalisation outcomes and mortality
We showed that early rehospitalisation was an independent predictor of 1-year mortality, in line with prior reports on long-term survival.7 10 HF rehospitalisation after TAVI is itself strongly associated with later death in prior studies,10 20 which suggests that it may depict persistent diastolic dysfunction, pulmonary hypertension, concomitant valve disease or other irreversible structural damage that is not corrected by aortic valve implantation alone. For infection, the most important point is that in this population it may represent both frailty and, in a subset, prosthetic valve endocarditis, which carries very high mortality after TAVI.30 For bradycardia, the link is probably less direct than for HF, but still plausible. After TAVI, bradycardias often reflect conduction system injury, can require PPM implantation and may be associated with later HF hospitalisation and, in some studies, higher all-cause mortality.31 However, the association between early rehospitalisation and increased 1-year mortality should be interpreted with caution. Early rehospitalisation likely reflects a more vulnerable and comorbid patient population rather than a direct causal factor for mortality. Nevertheless, it may serve as a useful clinical marker to identify high-risk individuals who could benefit from closer follow-up, optimisation of medical therapy and earlier recognition of complications, particularly those requiring intensive care unit admission or prolonged hospitalisation, with the aim of reducing rehospitalisation rates and potentially mitigate mortality risk in some of them.
Intensified follow-up
Although recent guidelines recommend scheduling the initial echocardiographic follow-up visit within the first weeks after TAVI,3 we still do not know which patients require closer post-TAVI surveillance. At the same time, there is an ongoing effort to intensify patient follow-up care promptly in the setting of reduced length of stay, as investigated in the randomised controlled Impact of Intensified Outpatient Follow-Up on Rehospitalization After Transcatheter Aortic Valve Implantation(HOSPTAVI) trial.32 There is also evidence that enables early discharge with the utilisation of artificial intelligence programmes and telemedicine after TAVI,26 similar with HF virtual surveillance programmes.33 Early postdischarge follow-up has been shown to lower HF rehospitalisation rates in chronic HF34 and can also work in reducing the post-TAVI HF rehospitalisation burden.
Limitations
Our study has some limitations that need to be addressed. As an observational, retrospective study, causality cannot be implied. Furthermore, despite multivariable adjustment, the risk of residual confounding effect remains. It is also important to note that this was a single centre study, so external validity may be limited. Additionally, some variables, including frailty and functional status, were not fully collected. Although we had access to most clinical records, rehospitalisations occurring at external institutions may not have been fully recorded, potentially leading to underestimation of event rates. Finally, despite the large cohort, prevalence of some outcomes was low, which may have limited statistical power for subgroup analyses. Therefore, our findings should be validated in larger, prospective, multicentre studies.
Clinical relevance
The identification of variables that stratify by rehospitalisation risk is essential for developing cost-efficient monitoring strategies and for targeting potentially modifiable factors. Future large-scale studies should aim to examine the efficacy of interventions directed at preventing rehospitalisations, particularly those that may be avoidable and to assess whether different post-TAVI follow-up pathways can reduce rehospitalisation and mortality rates while improving quality of life. At the same time, as not all rehospitalisations can be prevented, a key message highlighted by this study is the importance of recognising this subgroup as being at significantly increased risk of adverse future outcomes. Therefore, intensified surveillance and tailored follow-up strategies should be considered for these patients.
Conclusions
In summary, this study analysed the causes and predictors of early rehospitalisation after TAVI in a large, all-comer, real-world population. The three most prevalent causes were infection, HF and bradycardia. Modifiable risk factors included contrast dye volume, mild or greater paravalvular leak and discharge conduction abnormalities, whereas early discharge did not increase the risk of readmission. Lastly, early rehospitalisation was associated with a threefold increase in the risk of subsequent 1-year mortality.
Supplementary material
Footnotes
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Provenance and peer review: Not commissioned; externally peer reviewed.
Patient consent for publication: Not applicable.
Ethics approval: All patients were enrolled in the prospective SwissTAVI registry (NCT01368250) and provided written informed consent. The registry has been approved by the responsible ethics committee.
Data availability statement
Data are available upon reasonable request.
References
- 1.Durko AP, Osnabrugge RL, Van Mieghem NM, et al. Annual number of candidates for transcatheter aortic valve implantation per country: current estimates and future projections. Eur Heart J. 2018;39:2635–42. doi: 10.1093/eurheartj/ehy107. [DOI] [PubMed] [Google Scholar]
- 2.Tan MC, Yeo YH, San BJ, et al. Trends and Disparities in Valvular Heart Disease Mortality in the United States From 1999 to 2020. J Am Heart Assoc. 2024;13:e030895. doi: 10.1161/JAHA.123.030895. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Praz F, Borger MA, Lanz J, et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2025;46:4635–736. doi: 10.1093/eurheartj/ehaf194. [DOI] [PubMed] [Google Scholar]
- 4.Danielsen SO, Moons P, Sandven I, et al. Thirty-day readmissions in surgical and transcatheter aortic valve replacement: A systematic review and meta-analysis. Int J Cardiol. 2018;268:85–91. doi: 10.1016/j.ijcard.2018.05.026. [DOI] [PubMed] [Google Scholar]
- 5.Kolte D, Tale A, Song Y, et al. Relationship between hospital mortality and readmission rates after transcatheter aortic valve replacement. Eur Heart J Qual Care Clin Outcomes. 2025;11:580–6. doi: 10.1093/ehjqcco/qcae102. [DOI] [PubMed] [Google Scholar]
- 6.Patel RV, Ravindran M, Manoragavan R, et al. Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review. CJC Open . 2022;4:792–801. doi: 10.1016/j.cjco.2022.05.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Nombela-Franco L, del Trigo M, Morrison-Polo G, et al. Incidence, Causes, and Predictors of Early (≤30 Days) and Late Unplanned Hospital Readmissions After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2015;8:1748–57. doi: 10.1016/j.jcin.2015.07.022. [DOI] [PubMed] [Google Scholar]
- 8.Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–28. doi: 10.1056/NEJMsa0803563. [DOI] [PubMed] [Google Scholar]
- 9.Généreux P, Piazza N, et al. VARC-3 WRITING COMMITTEE Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research. J Am Coll Cardiol. 2021;77:2717–46. doi: 10.1016/j.jacc.2021.02.038. [DOI] [PubMed] [Google Scholar]
- 10.Bække PS, Jørgensen TH, Thuraiaiyah J, et al. Incidence, predictors, and prognostic impact of rehospitalization after transcatheter aortic valve implantation. Eur Heart J Qual Care Clin Outcomes. 2024;10:446–55. doi: 10.1093/ehjqcco/qcad067. [DOI] [PubMed] [Google Scholar]
- 11.Zahid S, Din MTU, Khan MZ, et al. Trends, Predictors, and Outcomes of 30-Day Readmission With Heart Failure After Transcatheter Aortic Valve Replacement: Insights From the US Nationwide Readmission Database. J Am Heart Assoc. 2022;11:e024890. doi: 10.1161/JAHA.121.024890. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Kolte D, Khera S, Sardar MR, et al. Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States. Circ: Cardiovascular Interventions. 2017;10 doi: 10.1161/CIRCINTERVENTIONS.116.004472. [DOI] [PubMed] [Google Scholar]
- 13.Huded CP, Tuzcu EM, Krishnaswamy A, et al. Association Between Transcatheter Aortic Valve Replacement and Early Postprocedural Stroke. JAMA. 2019;321:2306–15. doi: 10.1001/jama.2019.7525. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Arai T, Yashima F, Yanagisawa R, et al. Hospital readmission following transcatheter aortic valve implantation in the real world. Int J Cardiol. 2018;269:56–60. doi: 10.1016/j.ijcard.2018.07.073. [DOI] [PubMed] [Google Scholar]
- 15.Tripathi B, Nerusu LA, Sawant AC, et al. Transcatheter Aortic Valve Implantation Readmissions in the Current Era (from the National Readmission Database) Am J Cardiol. 2020;130:115–22. doi: 10.1016/j.amjcard.2020.06.020. [DOI] [PubMed] [Google Scholar]
- 16.Amgai B, Patel N, Chakraborty S, et al. 30-day readmission following urgent and elective transcatheter aortic valve replacement: A Nationwide Readmission Database analysis. Catheter Cardiovasc Interv. 2021;98:E1026–32. doi: 10.1002/ccd.29918. [DOI] [PubMed] [Google Scholar]
- 17.Tomii D, Okuno T, Heg D, et al. Validation of the VARC-3 Technical Success Definition in Patients Undergoing TAVR. JACC Cardiovasc Interv. 2022;15:353–64. doi: 10.1016/j.jcin.2021.11.013. [DOI] [PubMed] [Google Scholar]
- 18.Brunner S, Moccetti F, Loretz L, et al. The impact of elevated C-reactive protein levels on long-term outcomes of patients undergoing transcatheter aortic valve replacement. Cardiovasc Revasc Med. 2025;70:71–5. doi: 10.1016/j.carrev.2024.07.002. [DOI] [PubMed] [Google Scholar]
- 19.Ross JS. Statistical Models and Patient Predictors of Readmission for Heart Failure. Intern Med. 2008;168:1371. doi: 10.1001/archinte.168.13.1371. [DOI] [PubMed] [Google Scholar]
- 20.Nazzari H, Hawkins NM, Ezekowitz J, et al. The Relationship Between Heart-Failure Hospitalization and Mortality in Patients Receiving Transcatheter Aortic Valve Replacement. Can J Cardiol. 2019;35:413–21. doi: 10.1016/j.cjca.2018.11.016. [DOI] [PubMed] [Google Scholar]
- 21.Matsushita K, Marchandot B, Trimaille A, et al. Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch. ESC Heart Fail. 2023;10:2183–99. doi: 10.1002/ehf2.14435. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Pibarot P, Hahn RT, Weissman NJ, et al. Association of Paravalvular Regurgitation With 1-Year Outcomes After Transcatheter Aortic Valve Replacement With the SAPIEN 3 Valve. JAMA Cardiol. 2017;2:1208–16. doi: 10.1001/jamacardio.2017.3425. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Sá MP, Jacquemyn X, Van den Eynde J, et al. Impact of Paravalvular Leak on Outcomes After Transcatheter Aortic Valve Implantation: Meta-Analysis of Kaplan-Meier-derived Individual Patient Data. Struct Heart . 2023;7:100118. doi: 10.1016/j.shj.2022.100118. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Gotzmann M, Lindstaedt M, Mügge A. From pressure overload to volume overload: aortic regurgitation after transcatheter aortic valve implantation. Am Heart J. 2012;163:903–11. doi: 10.1016/j.ahj.2012.03.017. [DOI] [PubMed] [Google Scholar]
- 25.Hodel C, Moccetti F, Brunner S, et al. Long-Term Outcomes After Transcatheter Aortic Valve Replacement Complicated by New-Onset Persistent Left Bundle Branch Block. Catheter Cardiovasc Interv. 2025;105:1545–51. doi: 10.1002/ccd.31491. [DOI] [PubMed] [Google Scholar]
- 26.Herrero-Brocal M, Samper R, Riquelme J, et al. Early discharge programme after transcatheter aortic valve implantation based on close follow-up supported by telemonitoring using artificial intelligence: the TeleTAVI study. Eur Heart J Digit Health . 2025;6:73–81. doi: 10.1093/ehjdh/ztae089. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Ooms JF, Cornelis K, Wijeysundera HC, et al. Safety and feasibility of early discharge after transcatheter aortic valve implantation with ACURATE Neo-the POLESTAR trial. Clin Res Cardiol. 2025;114:341–9. doi: 10.1007/s00392-024-02436-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Wood DA, Lauck SB, Cairns JA, et al. The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study. JACC Cardiovasc Interv. 2019;12:459–69. doi: 10.1016/j.jcin.2018.12.020. [DOI] [PubMed] [Google Scholar]
- 29.Durand E, Beziau-Gasnier D, Michel M, et al. Reducing length of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial. Eur Heart J. 2024;45:952–62. doi: 10.1093/eurheartj/ehae081. [DOI] [PubMed] [Google Scholar]
- 30.Tinica G, Tarus A, Enache M, et al. Infective endocarditis after TAVI: a meta-analysis and systematic review of epidemiology, risk factors and clinical consequences. Rev Cardiovasc Med. 2020;21:263–74. doi: 10.31083/j.rcm.2020.02.68. [DOI] [PubMed] [Google Scholar]
- 31.Pagnesi M, Kim W-K, Baggio S, et al. Incidence, Predictors, and Prognostic Impact of New Permanent Pacemaker Implantation After TAVR With Self-Expanding Valves. JACC Cardiovasc Interv. 2023;16:2004–17. doi: 10.1016/j.jcin.2023.05.020. [DOI] [PubMed] [Google Scholar]
- 32.Bække PS, Jørgensen TH, Bieliauskas G, et al. Impact of Intensified Outpatient Follow-Up on Rehospitalization After Transcatheter Aortic Valve Implantation: Results From the HOSPITAVI Trial. Am J Cardiol. 2025;245:17–24. doi: 10.1016/j.amjcard.2025.01.031. [DOI] [PubMed] [Google Scholar]
- 33.Lee KC-S, Breznen B, Ukhova A, et al. Virtual healthcare solutions in heart failure: a literature review. Front Cardiovasc Med. 2023;10:1231000. doi: 10.3389/fcvm.2023.1231000. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Bradley EH, Curry L, Horwitz LI, et al. Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circ Cardiovasc Qual Outcomes. 2013;6:444–50. doi: 10.1161/CIRCOUTCOMES.111.000101. [DOI] [PMC free article] [PubMed] [Google Scholar]
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Data Availability Statement
Data are available upon reasonable request.