Impact of Adverse Events on Costs and Length of Stay Following Transcatheter Tricuspid Valve Replacement.

Background: Transcatheter tricuspid valve replacement (TTVR) with the EVOQUE system has emerged as an effective therapy for severe tricuspid regurgitation. The costs and resource utilization associated with TTVR, particularly in the context of major adverse events (MAEs), remain uncharacterized. The objective of the study was to quantify the impact of in-hospital MAEs on length of stay (LOS) and costs of TTVR admissions. Methods: This analysis included patients with symptomatic, ≥severe tricuspid regurgitation who underwent TTVR in the TRISCEND II trial. Hospital billing data were obtained for 155 patients to assess procedural costs, nonprocedural costs, and LOS. MAEs during the index hospitalization were adjudicated, and their impact on costs and LOS were evaluated using multivariable regression models. Results: The mean total LOS was 6.4 ± 5.5 days, with mean admission costs of $80,005 ± $26,958 including the device cost. MAEs occurred in 20% of patients and most commonly consisted of new pacemaker or cardiac implantable electronic device (CIED) implantation (9.7%) and severe bleeding (9.0%). Adjusted analyses identified new renal replacement therapy (RRT) ($75,308, frequency 1.9%) and new pacemaker or CIED implantation ($34,322) as the largest independent contributors to increased costs. New RRT (13.0 days), stroke (10.1 days), and new pacemaker or CIED (4.2 days) were associated with the greatest increases in LOS. Overall, MAEs accounted for $5156 and 0.7 days per patient of the total index admission cost and LOS, respectively. Conclusions: In the TRISCEND II trial, new pacemaker or CIED implantation and new RRT most substantially increased hospital costs and LOS following TTVR.