Association of Comorbidity Burden With In-Hospital Mortality in Transcatheter Aortic Valve Replacement Patients With Coexisting Malignancy in the United States: A Retrospective Cohort Study.

Background Patients with malignancy undergoing transcatheter aortic valve replacement (TAVR) are a growing, high-risk group. The impact of overall comorbidity burden beyond malignancy itself on outcomes is unclear. Objectives To evaluate the association between comorbidity burden (Elixhauser Comorbidity Index, excluding malignancy) and in-hospital mortality in TAVR patients with coexisting malignancy, stratified by malignancy type and disease activity. Methods Using the 2022 National Inpatient Sample, we identified TAVR hospitalizations with coexisting malignancy. Malignancies were classified as solid or hematologic; active disease was defined by chemotherapy, radiation, or metastatic codes. Comorbidity burden was stratified as low, moderate, or high. The primary outcome was in-hospital mortality. Multivariable logistic regression adjusted for patient, hospital, and malignancy-specific factors. Results Among 2,364 hospitalizations (weighted n=11,820 nationally; mean age 77.4 years; 44.2% female), solid tumors accounted for 87.6% of the cases and hematologic malignancies for 12.4%. Active malignancy was present in 34.2% overall (32.8% solid, 44.6% hematologic). High comorbidity burden was seen in 38.6% of the patients. Overall, in-hospital mortality was 3.2%, rising from 1.1% (low burden) to 5.4% (high burden). On adjusted analysis, high comorbidity burden, active malignancy, hematologic malignancy, metastatic disease, and nonelective admission were independent predictors of mortality. Conclusions In TAVR patients with malignancy, higher comorbidity burden is independently associated with increased in-hospital mortality. Comprehensive comorbidity assessment should inform preprocedural risk stratification.