End-stage renal disease tied to higher mortality with TAVR

  • J Am Coll Cardiol
  • 4 Jun 2019

  • International Clinical Digest
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Takeaway

  • End-stage renal disease (ESRD) is associated with higher in-hospital mortality and bleeding after transcatheter aortic valve replacement (TAVR).

Why this matters

  • Patients with ESRD may survive the procedure and hospitalization but remain at increased risk for early death.
  • “The 1-year survival raises concerns regarding diminished benefit in this population. TAVR should be used judiciously after full discussion of the risk-benefit ratio in patients on dialysis,” the authors warn.

Study design

  • Analysis of data for the first 72,631 patients with severe aortic stenosis (52.2% men) undergoing TAVR in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) registry.
  • 3053 patients (4.2%) had ESRD.
  • Funding: None disclosed.

Key results

  • Patients with ESRD tended to be younger (mean, 78 vs 84 years; P<.01 with higher sts procedural operative mortality score vs p because of prevalence comorbidities.>
  • Patients with ESRD had:
    • Higher rate of major bleeding (1.4% vs 1.0%; P=.03) but not major vascular complications (P=.86).
    • Higher in-hospital mortality (5.1% vs 3.4%; P<.001 but lower observed ratio vs p>
  • Dialysis was a significant predictor of 1-year mortality (36.8% vs 18.7%; P<.01 ahr="1.28;" p>
  • In-hospital mortality rate increased with STS-PROM: 15%, 7.0%.

Limitations

  • Observational design.
  • O:E ratio calculated on in-hospital vs 30-day mortality.

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