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