Outcomes of transcatheter aortic valve replacement in end stage liver and renal disease

Abstract

Objectives This study evaluates in‐hospital, 30‐day, and 1‐year outcomes post‐transcatheter aortic valve replacement (TAVR) in end stage liver disease (ESLD) and/or end stage renal disease (ESRD) compared with patients without these comorbidities. Background TAVR is an alternative to surgical aortic valve replacement in patients with ESLD and ESRD, though current outcomes data are limited. Methods We compared 309 patients (N = 29 ESLD and/or ESRD, N = 280 control) age > 18 who underwent transfemoral TAVR from 2014 to 2020 have been compared. Results Patients with ESLD and ESRD were younger (69.9 ± 11.7 vs. 79.1 ± 9.8, p < .01) with higher STS‐PROM scores (8.1 ± 6.7 vs. 4.6 ± 3.9, p < .01). ESRD and ESLD patients had similar rates of in‐hospital major vascular complications (3.4% vs. 3.2%, p = .96), major bleeding events (3.4% vs. 3.2%, p = .95), and mortality (0.0% vs. 1.8%, p = .47). Mortality rates were similar at 30‐days (3.4% vs. 2.1%, p = .65) with trend to higher mortality at 6‐months (6.9% vs. 3.2%, p = .31) and 1‐year (15.4% vs. 7.0%, p = .13). Readmission rates were higher in the ESLD and ESRD cohort at 6‐months (53.2% vs. 28.6%, p < .01) and 1‐year (65.4% vs. 41.0%, p = .02). One patient received dual kidney–liver transplant, 1 patient received a liver transplant, and 7 additional patients were listed for transplant. Conclusion Patients with ESLD and/or ESRD who underwent TAVR had similar mortality at discharge and 30‐days compared with patients without these comorbidities with a trend toward increased mortality at 1‐year. This study suggests that TAVR is an option for aortic valve disease patients with ESRD and/or ESLD in order to remove cardiac barriers to liver or kidney transplant.

Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review

“…2017 48 C 3 L 1124 85 (82–88) 69.8 6.7 (4.7–9.4) — — 78.8 — — — Caughron et al. 2021 49 C 6 B 309 78.2 ± 10.3 44.3 5 ± 4.4 75.7 24.3 0 Ando et al. 2020 50 C 4 E 5731 74 ± 10.1 38.1 — — — — — — — Feldman et al.…”

Transcatheter Aortic Valve Replacement Restoring Candidacy for Liver Transplant in Patients With Cirrhosis

“…Caughron et al concluded that the mortality at discharge and at 30 days was similar in both groups, suggesting no increased risk initially but with an upward trend of mortality at 1 year after TAVR. 16 Ultimately, this case suggests the potential TAVR has at overcoming the cardiac barriers that are imposed on a successful OLT.…”

Optimizing cardiac status in the preliver transplant candidate

“…With the development and refinement of percutaneous valve techniques, some of these risks may be mitigated. A retrospective analysis [15] of adults who underwent transfemoral transaortic valve replacement (TAVR) for severe aortic valve disease compared a group of combined ESLD patients ( n = 15) and end-stage kidney disease (ESRD) patients ( n = 17) with non-ESLD/non-ESRD controls ( n = 280). In the ESLD subgroup, there was one vascular event (6.7%) and one patient requiring pacemaker (6.7%), but no cerebrovascular events or mortality during the index hospitalization.…”