Abstract
BACKGROUND: Outcomes of structural heart disease (SHD) interventions may be affected by prior mediastinal radiation. OBJECTIVES: The objective of the study was to evaluate the outcomes of SHD interventions among patients with vs without prior mediastinal radiation. METHODS: We analyzed the Nationwide Readmissions Database (2016-2022) to identify patients aged ≥18 years with prior mediastinal radiation who underwent SHD interventions. The primary outcome was in-hospital mortality. Secondary outcomes included procedural complications, resource utilization (length of stay, costs, discharge disposition), and 90-day readmissions. In-hospital outcomes were analyzed with logistic regression and readmissions with Cox proportional hazards models. RESULTS: Among 810,849 weighted hospitalizations for transcatheter aortic valve replacement, mitral transcatheter edge-to-edge repair, transcatheter mitral valve replacement, and left atrial appendage occlusion, 1.3% included patients with prior mediastinal radiation. Utilization rates (procedures/100,000 hospitalizations) were higher in patients with vs without prior mediastinal radiation for transcatheter aortic valve replacement (577 vs 254), mitral transcatheter edge-to-edge repair (70 vs 35), and transcatheter mitral valve replacement (11 vs 4) (all P < 0.001). There were no significant differences in adjusted in-hospital mortality, complications, or resource utilization between patients with vs without prior mediastinal radiation following any of the 4 SHD interventions. Ninety-day readmissions were similar after transcatheter aortic and mitral valve interventions but higher after left atrial appendage occlusion (adjusted HR: 1.51; 95% CI: 1.21-1.89) in patients with vs without prior mediastinal radiation. CONCLUSIONS: Transcatheter aortic and mitral valve interventions are performed more frequently in patients with vs without prior mediastinal radiation with similar in-hospital outcomes and readmissions. Readmissions after LAAO are higher in patients with vs without prior mediastinal radiation.