Increased Rate of Intermediate-Term Valve Failure After TAVR in End-Stage Renal Disease Patients Requiring Maintenance Dialysis.

BACKGROUND

Transcatheter aortic valve replacement (TAVR) has been widely adopted, but outcomes in end-stage renal disease (ESRD) patients on hemodialysis (HD) have not been extensively studied.

METHODS

A total of 1260 TAVRs were performed at our center between December 2011 and October 2018, including 86 patients (6.82%) with ESRD on HD. Comparisons were made between baseline demographics, preoperative risk, hemodynamics, and reintervention, as well as survival at 30 days, 1 year, and 2 years.

RESULTS

Age at TAVR was 62.7 ± 12.1 years in the ESRD-HD group vs 72.3 ± 5.9 years in the non-ESRD group (P<.01). STS scores were 10.2 ± 1.3% in the ESRD-HD group vs 8.1 ± 1.1% in the non-ESRD group (P<.01). Mortality rates were different between the ESRD-HD group and the non-ESRD group (30-day mortality, 5.8% vs 3.1%, respectively [P=.05]; 1-year mortality, 25.1% vs 13.6%, respectively [P<.01]; 2-year mortality, 51.6% vs 23.0%, respectively [P<.01]). Baseline aortic valve areas (AVAs) were comparable; however, ESRD-HD patients had higher gradients than non-ESRD patients at every postprocedural interval assessed (30-day AVA, 1.47 ± 0.2 cm² vs 1.32 ± 0.1 cm², respectively [P<.001]; 1-year AVA, 1.39 ± 0.1 cm² vs 1.05 ± 0.1 cm², respectively [P<.01]; 2-year AVA, 1.28 ± 0.1 cm² vs 0.77 ± 0.05 cm² , respectively [P<.01]). Repeat TAVR was needed within 2 years in 5 ESRD-HD patients (6.8%) and 1 non-ESRD patient (0.01%).

CONCLUSIONS

In our single-center cohort, the ESRD-HD TAVR group demonstrated significantly higher rates of need for valvular reintervention (6.8% vs 0.01%) at 2 years, as well as higher mortality rates at 30 days, 1 year, and 2 years.