Impact of Renal Dysfunction on Results of Transcatheter Aortic Valve Replacement Outcomes in a Large Multicenter Cohort

Codner, Pablo; Levi, Amos; Gargiulo, Giuseppe; Praz, Fabien; Hayashida, Kentaro; Watanabe, Yusuke; Mylotte, Darren; Debry, Nicolas; Barbanti, Marco; Lefèvre, Thierry; Modine, Thomas; Bosmans, Johan; Windecker, Stephan; Barbash, Israel M.; Sinning, Jan Malte; Nickenig, Georg; Barsheshet, Alon; Kornowski, Ran

doi:10.1016/j.amjcard.2016.08.082

Cited by 40 publications

(40 citation statements)

References 26 publications

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Section: Discussionsupporting

confidence: 88%

“…Consistent with others, we found a high frequency of moderate/severe CKD among the high‐ to extreme‐risk patients undergoing TAVR and high‐risk patients randomized to SAVR, which is likely to be multifactorial. While previous studies provided short‐term outcomes, the UK TAVI registry and the present study provide mid‐term (3‐year) outcomes. Additionally, unlike previous studies, our analysis specifically evaluated the impact of CKD on the outcomes of high‐ and extreme‐risk patients undergoing TAVR similar to one prior study from the PARTNER 1 trial.…”

Section: Discussionsupporting

confidence: 88%

“…While previous studies provided short‐term outcomes, the UK TAVI registry and the present study provide mid‐term (3‐year) outcomes. Additionally, unlike previous studies, our analysis specifically evaluated the impact of CKD on the outcomes of high‐ and extreme‐risk patients undergoing TAVR similar to one prior study from the PARTNER 1 trial.…”

Section: Discussionmentioning

confidence: 99%

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Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Pineda

Harrison

Kleiman

et al. 2018

Cathet Cardio Intervent

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Objectives To assess the treatment effect of TAVR versus SAVR on clinical outcomes to 3 years in patients stratified by chronic kidney disease (CKD) by retrospectively studying patients randomized to TAVR or SAVR. Background The impact of CKD on mid‐term outcomes of patients undergoing TAVR versus SAVR is unclear. Methods Patients randomized to TAVR or SAVR in the CoreValve US Pivotal High Risk Trial were retrospectively stratified by eGFR: none/mild or moderate/severe CKD. To evaluate the impact of baseline CKD in TAVR patients only, all patients undergoing an attempted TAVR implant in the US Pivotal Trial and CAS were stratified by baseline eGFR into none/mild, moderate, and severe CKD. The primary endpoint was major adverse cardiovascular and renal events (MACRE), a composite of all‐cause mortality, myocardial infarction, stroke/TIA, and new requirement of dialysis. Results Moderate/severe CKD was present in 62.7% and 60.7% of high‐risk patients randomized to TAVR or SAVR, respectively. Baseline characteristics were similar between TAVR and SAVR patients in both CKD subgroups, except for higher rates of diabetes and higher serum creatinine in SAVR patients. Among high‐risk patients with moderate/severe CKD, TAVR provided a lower 3‐year MACRE rate compared with SAVR: 42.1% vs. 51.0, P = .04. Of 3,733 extreme‐ and high‐risk TAVR patients, 39.9% had none/mild, 53.8% moderate, and 6.4% severe CKD. Worsening baseline CKD was associated with increased 3‐year MACRE rates [none/mild 51.5%, moderate 54.5%, severe 63.1%, P = .001]. Conclusions TAVR results in lower 3‐year MACRE versus SAVR in high‐risk patients with moderate/severe CKD. In patients undergoing TAVR, worsening CKD increases mid‐term mortality and MACRE. Randomized trials of TAVR vs. SAVR in patients with moderate‐severe CKD would help elucidate the best treatment for these complex patients. Trial Registration CoreValve US Pivotal Trial: NCT01240902. CoreValve Continued Access Study: NCT01531374.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Pineda

Harrison

Kleiman

et al. 2018

Cathet Cardio Intervent

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“…Our result showed that benefits of TAVR could be extended in patients with advanced kidney disease who cannot undergo surgery. Overall mortality in patients with advanced CKD is higher with TAVR as well as SAVR compared with previous studies with normal to mildly impaired kidney functions . This is observed in our study as well.…”

Section: Discussionsupporting

confidence: 84%

Transcatheter or surgical aortic valve replacement in patients with advanced kidney disease: A propensity score–matched analysis

Doshi

Shah

Patel

et al. 2017

Clinical Cardiology

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Background Transcatheter aortic valve replacement (TAVR) is an alternative for surgically inoperable patients with severe aortic stenosis. Advanced kidney disease may significantly affect outcomes in patients treated with TAVR and surgical aortic valve replacement (SAVR). Hypothesis TAVR is associated with better in‐hospital outcomes compared with SAVR in patients with advanced kidney disease. Methods We identified our sample from the National Inpatient Sample between 2012 and 2014, using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We included patients with chronic kidney disease stages IV and V and end‐stage renal disease as advanced kidney disease patients. We excluded patients with acute kidney injury on admission and patients on dialysis. Results After propensity matching, 2485 patients were included in each group. The primary outcome of in‐hospital mortality (12.9% vs 6.2%; P < 0.01) was higher with SAVR as compared with TAVR. Patients who underwent SAVR reported higher acute kidney injury (50.3% vs 33%; P < 0.01) and dialysis requirements (26.8% vs 20.1%; P < 0.01). Other secondary outcomes including blood transfusion, atrial fibrillation, iatrogenic cardiac complications, pericardial complications, perioperative stroke, perioperative infections, and postoperative shock were more common with SAVR. With SAVR, the length of hospitalization and hospitalization costs were significantly higher; however, permanent pacemaker placement was more common with TAVR compared with SAVR. Conclusions In patients with advanced kidney disease, SAVR was associated with higher mortality and higher periprocedural complications, as compared with TAVR. Thus, benefits of TAVR could be extended in patients with advanced kidney disease who cannot undergo surgery.

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“…However, most studies conducted prior to Hansen et al found this association insignificant. The association between stage 4 or 5 CKD and increased mortality was reported as significant in later studies . However, several studies did not report significant association between CKD and risk of mortality in TAVR patients .…”

Section: Discussionsupporting

confidence: 46%

Chronic kidney disease is associated with increased mortality and procedural complications in transcatheter aortic valve replacement: a systematic review and meta‐analysis

Rattanawong

Kanitsoraphan

Kewcharoen

et al. 2019

Cathet Cardio Intervent

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Objective We performed a systematic review and meta‐analysis to explore the association between chronic kidney disease (CKD) and mortality and procedural complications in transcatheter aortic valve replacement (TAVR). Background The impact of varying stages of CKD or end‐stage renal disease (ESRD) on patients receiving TAVR is not clearly identified. Methods We searched the databases of MEDLINE and EMBASE from inception to May 2018. Included studies were published TAVR studies that compared the risk of mortality and procedural complications in CKD patients compared to control patients. Data from each study were combined using the random‐effects model. Results Twelve studies (42,703 CKD patients and 51,347 controls) were included. Compared with controls, CKD patients had a significantly higher risk of 30‐day overall mortality (risk ratio [RR] = 1.56, 95% confidence interval [CI]: 1.34–1.80, I2 = 60.9), long‐term cardiovascular mortality (RR = 1.44, 95% CI: 1.22–1.70, I2 = 36.2%), and long‐term overall mortality (RR = 1.66, 95% CI: 1.45–1.91, I2 = 80.3), as well as procedural complications including pacemaker requirement (RR = 1.20, 95% CI: 1.03–1.39, I2 = 56.1%) and bleeding (RR = 1.60, 95% CI: 1.26–2.02, I2 = 86.0%). Risk of mortality and procedural complications increased with severity of CKD for stages 3, 4, and 5, respectively, in terms of long‐term overall mortality (RR = 1.28, 1.82, and 2.12), 30‐day overall mortality (RR = 1.26, 1.89, and 1.93), 30‐day cardiovascular mortality (RR = 1.18, 1.75, and 2.50), and 30‐day overall bleeding (RR = 1.19, 1.63, and 2.12). Conclusions Our meta‐analysis demonstrates a significant increased risk of mortality and procedural complications in patients with CKD who underwent TAVR compared to controls.

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Impact of Renal Dysfunction on Results of Transcatheter Aortic Valve Replacement Outcomes in a Large Multicenter Cohort

Cited by 40 publications

References 26 publications

Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Transcatheter or surgical aortic valve replacement in patients with advanced kidney disease: A propensity score–matched analysis

Chronic kidney disease is associated with increased mortality and procedural complications in transcatheter aortic valve replacement: a systematic review and meta‐analysis

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