The outcomes of transcatheter aortic valve replacement in a cohort of patients with end‐stage renal disease

Abstract

Objectives: To examine whether transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for aortic stenosis in patients with end-stage renal disease (ESRD). Background: Patients with ESRD undergoing surgical aortic valve replacement have an operative mortality approaching 20% and a 10-year survival of approximately 12%. We investigated whether TAVR is a more reasonable option. Methods: This is a multicenter, retrospective study of all patients with ESRD who underwent TAVR in 8 institutions between 12/2011 and 02/2013. Demographic characteristics, (2016) mortality, major, and minor complications were evaluated. Outcomes were stratified by operative approach. Results: Forty-three patients with a mean age 76.2 6 11.0 years and a mean STS predicted risk of mortality of 15.53 6 8.70% underwent TAVR. Mean duration of dialysis was 45.2 6 52.3 months (median 29.5 months). Transfemoral (TF) TAVR was performed in 31/43 (72.1%), transapical in 11/43 (25.6%), and transaortic in 1/ 43 (2.3%). Operative mortality was 14.0% (6/43) with TF mortality 6.5% (2/31) and 33.3% (4/12) in non-TF patients. Six-month mortality was 11/43 (25.6%: 16.1% TF, 50.0% non-TF). Complications included stroke in 2.3% (1/43) and life-threatening or major bleeding in 14.0% (6/43). Discharge to another healthcare facility was 27.0% (10/37). Readmission within 30 days of procedure for any cause was 18.9% (7/37). Conclusions: Patients with ESRD who undergo TAVR are at high risk for mortality and complications. TAVR outcomes are comparable to but not substantially better than those with SAVR. Transfemoral TAVR seems to be at least as safe and effective as the current standard SAVR in patients undergoing aortic valve replacement. V C 2016 Wiley Periodicals, Inc.

Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States

“…[15][16][17][18] However, patients with CKD and CLD undergoing TAVR are at increased risk of procedural complications, mortality, and rehospitalization when compared with those without these conditions. 17,18 In addition to patient comorbidities, TA-TAVR and AKI were also identified as independent predictors of 30-day readmission. TA-TAVR is an accepted approach in patients in whom vascular anatomy or severe PVD precludes safe transfemoral (TF) access.…”

Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Patients on Maintenance Dialysis

“…Cardiovascular diseases are highly prevalent among dialysis patients, with aortic stenosis being the most common valvular disease affecting them 18–20 . The management of aortic stenosis in dialysis patients is becoming an increasingly relevant topic for two reasons: (1) The prevalence, risk profile and longevity of patients on dialysis have changed in the past two decades 21 .…”

“…Several small studies assessed the outcomes of TAVR in dialysis patients compared to those with normal renal function and found maintenance dialysis to be an independent predictor of in-hospital and long-term mortality 18, 24–29 . Dialysis status has now become a standard element in the TAVR risk prediction tool derived from large-scale data available in the ACC/TVT registry 30, 31 .…”

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

“…127 Operative mortality was 14%, similar to 19% in ESRD patients getting a SAVR. and mortality, however, TAVR seems to be at least as safe and effective as SAVR in patients undergoing AV repair.…”

“…studies on contrast load or osmolality, timing of contrast studies, volume expansion or holding diuretic strategies, use of bicarbonate solutions or NAC. Szerlip et al 127 performed a large multicenter retrospective study on the outcomes of TAVR in a national cohort of ESRD patients and found that ESRD patients who underwent TAVR were at high-risk for mortality (6-month mortality was 26%) with the rest of outcomes not substantially better than SAVR.…”