Faculty Collaboration Database

The outcomes of transcatheter aortic valve replacement in a cohort of patients with end-stage renal disease. Catheter Cardiovasc Interv 2016 Jun;87(7):1314-21

Date

03/08/2016

Pubmed ID

26946240

DOI

10.1002/ccd.26347

Scopus ID

2-s2.0-84975106014 (requires institutional sign-in at Scopus site)   27 Citations

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, mortality, major, and minor complications were evaluated. Outcomes were stratified by operative approach.

RESULTS: Forty-three patients with a mean age 76.2 ± 11.0 years and a mean STS predicted risk of mortality of 15.53 ± 8.70% underwent TAVR. Mean duration of dialysis was 45.2 ± 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. © 2016 Wiley Periodicals, Inc.

Author List

Szerlip M, Kim RJ, Adeniyi T, Thourani V, Babaliaros V, Bavaria J, Herrmann HC, Anwaruddin S, Makkar R, Chakravarty T, Rovin J, Creighton D, Miller DC, Baio K, Walsh E, Katinic J, Letterer R, Trautman L, Herbert M, Farkas R, Rudolph J, Brown D, Holper EM, Mack M

Author

Saif Anwaruddin MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Aortic Valve Stenosis
Cardiac Catheterization
Female
Heart Valve Prosthesis Implantation
Hospital Mortality
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic
Male
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States