Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease

被引:61
|
作者
Szerlip, Molly [1 ]
Zajarias, Alan [2 ]
Vemalapalli, Sreekanth [3 ]
Brennan, Matthew [3 ]
Dai, Dadi [3 ]
Maniar, Hersh [2 ]
Lindman, Brian R. [4 ]
Brindis, Ralph [5 ]
Carroll, John D. [6 ]
Hamandi, Mohanad [1 ]
Edwards, Fred H. [7 ]
Grover, Fred [6 ]
O'Brien, Sean [3 ]
Peterson, Eric [3 ]
Rumsfeld, John S. [6 ]
Shahian, Dave [8 ]
Tuzcu, E. Murat [9 ]
Holmes, David [10 ]
Thourani, Vinod H. [11 ,12 ]
Mack, Michael [1 ]
机构
[1] Baylor Scott & White Hlth, Plano, TX USA
[2] Washington Univ, Sch Med, St Louis, MO USA
[3] Duke Univ, Sch Med, Durham, NC USA
[4] Vanderbilt Univ, Sch Med, Nashville, TN 37212 USA
[5] Univ Calif San Francisco, Sch Med, San Francisco, CA USA
[6] Univ Colorado, Sch Med, Denver, CO USA
[7] Univ Florida, Sch Med, Jacksonville, FL USA
[8] Harvard Med Sch, Boston, MA 02115 USA
[9] Cleveland Clin Fdn, 9500 Euclid Ave, Cleveland, OH 44195 USA
[10] Mayo Clin, Rochester, MN USA
[11] MedStar Heart & Vasc Inst, Washington, DC USA
[12] Georgetown Univ, Sch Med, Washington, DC USA
关键词
aortic stenosis; end-stage renal disease; transcatheter aortic valve replacement; CHRONIC KIDNEY-DISEASE; POINT DEFINITIONS; CARDIAC-SURGERY; RISK; IMPLANTATION; MORTALITY; STENOSIS; OUTCOMES; VALIDATION; INSIGHTS;
D O I
10.1016/j.jacc.2019.03.496
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND In patients with end-stage renal disease (ESRD), surgical aortic valve replacement is associated with higher early and late mortality, and adverse outcomes compared with patients without renal disease. Transcatheter aortic valve replacement (TAVR) offers another alternative, but there are limited reported outcomes. OBJECTIVES The purpose of this study was to determine the outcomes of TAVR in patients with ESRD. METHODS Among the first 72,631 patients with severe aortic stenosis (AS) treated with TAVR enrolled in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) TVT (Transcatheter Valve Therapies) registry, 3,053 (4.2%) patients had ESRD and were compared with patients who were not on dialysis for demographics, risk factors, and outcomes. RESULTS Compared with the nondialysis patients, ESRD patients were younger (76 years vs. 83 years; p < 0.01) and had higher rates of comorbidities leading to a higher STS predicted risk of mortality (median 13.5% vs. 6.2%; p < 0.01). ESRD patients had a higher in-hospital mortality (5.1% vs. 3.4%; p < 0.01), although the observed to expected ratio was lower (0.32 vs. 0.44; p < 0.01). ESRD patients also had a similar rate of major vascular complications (4.5% vs. 4.6%; p = 0.86), but a higher rate of major bleeding (1.4% vs. 1.0%; p = 0.03). The 1-year mortality was significantly higher in dialysis patients (36.8% vs. 18.7%; p < 0.01). CONCLUSIONS Patients undergoing TAVR with ESRD are at higher risk and had higher in-hospital mortality and bleeding, but similar vascular complications, when compared with those who are not dialysis dependent. 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. (C) 2019 by the American College of Cardiology Foundation.
引用
收藏
页码:2806 / 2815
页数:10
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