TAVR and Dialysis Are a Challenging Combination. A Case Report and Systematic Review of Literature

Iadanza, Alessandro; Antenore, Alessandro; Biancofiore, Antonio; Contorni, Francesco; Biagioni, Giulia; Bellan, Cristiana; Davoli, Giuseppe; Fineschi, Massimo

doi:10.1080/24748706.2021.1967546

Cited by 2 publications

(4 citation statements)

References 26 publications

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“…30 When considering mechanical AVR for dialysis patients, clinicians must also regard the increased incidence of embolic events, the increased risk of bleeding associated with life-long anticoagulation and the possible rare relation of calciphylaxis identified with warfarin therapy. 31,32 With the increased occurrence of hospital readmission for patients who received mechanical AVRlikely due to the increased valve-related adverse complicationsbioprosthetic valves could be considered more appropriate for higher-risk dialysis-dependent patients. 33 Dialysis-dependent patients demonstrate accelerated degeneration of bioprosthetic valves, with research reporting moderate to severe degeneration present in 29% of patients at 5 years following bioprosthetic AVR.…”

Section: Discussionmentioning

confidence: 99%

“…However, the review notes the poor data quality due to suspected selection bias and therefore justified the recommendation of bioprosthetic AVR 30 . When considering mechanical AVR for dialysis patients, clinicians must also regard the increased incidence of embolic events, the increased risk of bleeding associated with life-long anticoagulation and the possible rare relation of calciphylaxis identified with warfarin therapy 31,32 . With the increased occurrence of hospital readmission for patients who received mechanical AVR – likely due to the increased valve-related adverse complications – bioprosthetic valves could be considered more appropriate for higher-risk dialysis-dependent patients 33 .…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter aortic valve implantation versus surgical aortic valve replacement in dialysis-dependent patients: a meta-analysis

Burton

Reynolds

King

et al. 2023

Journal of Cardiovascular Medicine

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Objectives This meta-analysis aims to compare the clinical outcomes of transcatheter aortic valve implantation (TAVI) versus aortic valve replacement (AVR) for aortic stenosis in dialysis-dependent patients. Methods Literature searches employed PubMed, Web of Science, Google Scholar and Embase to identify relevant studies. Bias-treated data were prioritized, isolated and pooled for analysis; raw data were utilized where bias-treated data were unavailable. Outcomes were analysed to assess for study data crossover. Results Literature search identified 10 retrospective studies; following data source analysis, five studies were included. Upon pooling of bias-treated data, TAVI was significantly favoured in early mortality [odds ratio (OR), 0.42; 95% confidence interval (95% CI), 0.19–0.92; I 2 = 92%; P = 0.03], 1-year mortality (OR, 0.88; 95% CI 0.80–0.97; I 2 = 0%; P = 0.01), rates of stroke/cerebrovascular events (OR, 0.71; 95% CI 0.55–0.93; I 2 = 0%; P = 0.01) and blood transfusions (OR, 0.36; 95% CI 0.21–0.62; I 2 = 86%; P = 0.0002). Pooling demonstrated fewer new pacemaker implantations in the AVR group (OR, 3.33; 95% CI 1.94–5.73; I 2 = 74%; P ≤ 0.0001) and no difference in the rate of vascular complications (OR, 2.27; 95% CI 0.60–8.59; I 2 = 83%; P = 0.23). Analysis including raw data revealed the length of hospital stay to favour TAVI with a mean difference of –9.20 days (95% CI –15.58 to –2.82; I 2 = 97%; P = 0.005). Conclusion Bias-treated meta-analysis comparing surgical AVR and TAVI favoured TAVI in early mortality, 1-year mortality, rates of stroke/cerebrovascular events and blood transfusions. There was no difference in the rates of vascular complications; however, TAVI required more pacemaker implantations. Data pooling including raw data revealed that the length of hospital admission favours TAVI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transcatheter aortic valve implantation versus surgical aortic valve replacement in dialysis-dependent patients: a meta-analysis

Burton

Reynolds

King

et al. 2023

Journal of Cardiovascular Medicine

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“…However, there are few reports of very rapid, early SVD in THVs in haemodialysis patients due to calcific stenosis. 4 Transcatheter aortic valve replacement-in-TAVR is attractive for SVD affecting THVs and the largest observational study (212 patients) has demonstrated good safety. 6 …”

Section: Discussionmentioning

confidence: 99%

“… 3 One such population is patients with ESKD requiring renal replacement therapy. 4 Although redo-TAVR is an attractive option for a failing THV a recently identified problem is sinus sequestration and impaired coronary access for selective coronary angiography following redo-TAVR. 5 The Acurate Neo is a nitinol, self-expanding, supra-annular THV, and is a relatively recent addition to the market.…”

Section: Introductionmentioning

confidence: 99%

Early Acurate Neo transcatheter heart valve degeneration in a haemodialysis patient successfully managed with Sapien 3 Ultra: a case report

Savvoulidis

Nadir

Ludman

et al. 2022

European Heart Journal - Case Reports

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Background Aortic valve disease is the most prevalent valvular abnormality in the developed world and carries a high risk of morbidity and mortality. Transcatheter aortic valve replacement (TAVR) is favored over open-heart surgery in high-risk patient categories and is increasingly used in lower risk groups. End stage kidney disease (ESKD) is associated with premature calcific degeneration of bioprosthetic heart valves. Redo-TAVR requires meticulous pre-procedural planning to avoid the important risks of sinus sequestration and impaired coronary access. TAVR with the Acurate Neo THV has been clinically available for a short time only and there are limited reports describing redo-TAVR in the Acurate Neo. Case summary We present a case of early, rapid onset, structural valve degeneration in a Acurate Neo, supra-annular, self-expanding transcatheter heart valve (THV) in a dialysis patient. The patient presented with chest pain and breathlessness 4 years after TAVR with a Acurate Neo for severe stenosis of a bicuspid aortic valve. Echocardiogram now showed severe stenosis of the THV and computed tomography revealed severe THV leaflet calcification but no pannus or leaflet thrombus. After careful pre-procedural planning a S3 Ultra balloon-expandable valve was selected and positioned relatively high to pin the first THV leaflets in a fully open position without compromising coronary artery flow or coronary access. Discussion ESKD may cause rapid, calcific degeneration of TAVR valves leading to presentation with severe aortic stenosis. Redo-TAVR in the Accurate Neo THV with a Sapien 3 Ultra is feasible with careful pre-procedural planning to mitigate the risks of sinus sequestration and impaired coronary access.

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TAVR and Dialysis Are a Challenging Combination. A Case Report and Systematic Review of Literature

Cited by 2 publications

References 26 publications

Transcatheter aortic valve implantation versus surgical aortic valve replacement in dialysis-dependent patients: a meta-analysis

Transcatheter aortic valve implantation versus surgical aortic valve replacement in dialysis-dependent patients: a meta-analysis

Early Acurate Neo transcatheter heart valve degeneration in a haemodialysis patient successfully managed with Sapien 3 Ultra: a case report

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