Intensive care utilization and clinical outcomes after transcatheter aortic valve implantation: a nationwide observational study using the Japanese intensive care patient database.

As transcatheter aortic valve implantation (TAVI) indications expand toward lower-risk populations, optimizing the allocation of intensive care unit (ICU) resources has become a pivotal concern for multidisciplinary Heart Teams. This nationwide retrospective cohort study utilized the Japanese Intensive Care Patient Database (JIPAD) to characterize clinical profiles and identify independent predictors of in-hospital mortality among 8,391 patients (mean age 84.0 years; 36.5% male) admitted directly to the ICU following TAVI between April 2015 and March 2024. Data were aggregated from 71 participating institutions across Japan. The overall in-hospital mortality rate was remarkably low at 1.1% (91/8,391), affirming the procedure’s safety even in a super-aging society. Compared with survivors, non-survivors required significantly more intensive organ support, specifically mechanical ventilation, extracorporeal membrane oxygenation, and renal replacement therapy. Multivariable logistic regression using generalized estimating equations identified maintenance hemodialysis (adjusted odds ratio [aOR], 6.24; 95% confidence interval [CI], 3.46–11.28), cardiac arrest prior to ICU admission (aOR, 5.36; 95% CI 1.73–16.56), and procedure-related complications (aOR, 9.62; 95% CI 4.60–20.10) as independent predictors of mortality. Post hoc risk stratification showed observed in-hospital mortality of 0.6% in patients with none of these three factors compared with 7.3% in those with at least one. These results provide an empirical basis for ICU-sparing pathways in uncomplicated cases while highlighting the need for intensive surveillance in high-risk individuals—particularly those on chronic dialysis or experiencing intraoperative adverse events—to optimize limited critical care resources.