Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Patients on Maintenance Dialysis

Fahad Alqahtani, Sami Aljohani, Khaled Boobes, Elad Maor, Assem Sherieh, Charanjit Rihal, David Holmes, Mohamad Alkhouli

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: The introduction of transcatheter aortic valve replacement (TAVR) expanded definitive therapy of aortic stenosis to many high-risk patients, but it has not been fully evaluated in the dialysis population. We aimed to evaluate the current trend and in-hospital outcome of surgical aortic valve replacement (SAVR) and TAVR in the dialysis population. Methods: Severe aortic stenosis patients on maintenance dialysis who underwent SAVR or TAVR in the Nationwide Inpatient Sample database from January 1, 2005, through December 31, 2014, were included in our comparative analysis. The trends of SAVR and TAVR were assessed. In-hospital mortality, rates of major adverse events, hospital length of stay, cost of care, and intermediate care facility utilization were compared between the 2 groups using both unadjusted and propensity-matched data. Results: Utilization of aortic valve replacement in dialysis patients increased 3-fold; a total of 2531 dialysis patients who underwent either SAVR (n = 2264) or TAVR (n = 267) between 2005 and 2014 were identified. Propensity score matching yielded 197 matched pairs. After matching, a 2-fold increase in in-hospital mortality was found with SAVR compared with TAVR (13.7% vs 6.1%, P = .021). Patients who underwent TAVR had more permanent pacemaker implantation (13.2% vs 5.6%, P = .012) but less blood transfusion (43.7% vs 56.8%, P = .02). Rates of other key morbidities were similar. Hospital length of stay (19 ± 16 vs 11 ± 11 days, P <.001) and non-home discharges (44.7% vs 31.5%, P = .002) were significantly higher with SAVR. Cost of hospitalization was 25% less with TAVR. Conclusion: In patients on maintenance dialysis, TAVR is associated with lower hospital mortality, resource utilization, and cost in comparison with SAVR.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StateAccepted/In press - 2017

Fingerprint

Surgical Instruments
Aortic Valve
Dialysis
Maintenance
Length of Stay
Hospital Mortality
Aortic Valve Stenosis
Costs and Cost Analysis
Intermediate Care Facilities
Transcatheter Aortic Valve Replacement
Propensity Score
Blood Transfusion
Population
Inpatients
Hospitalization
Databases
Morbidity
Mortality

Keywords

  • Aortic stenosis
  • Comparative outcomes
  • Dialysis
  • Surgical aortic valve replacement
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Alqahtani, F., Aljohani, S., Boobes, K., Maor, E., Sherieh, A., Rihal, C., ... Alkhouli, M. (Accepted/In press). Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Patients on Maintenance Dialysis. American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2017.05.031

Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Patients on Maintenance Dialysis. / Alqahtani, Fahad; Aljohani, Sami; Boobes, Khaled; Maor, Elad; Sherieh, Assem; Rihal, Charanjit; Holmes, David; Alkhouli, Mohamad.

In: American Journal of Medicine, 2017.

Research output: Contribution to journalArticle

Alqahtani, Fahad ; Aljohani, Sami ; Boobes, Khaled ; Maor, Elad ; Sherieh, Assem ; Rihal, Charanjit ; Holmes, David ; Alkhouli, Mohamad. / Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Patients on Maintenance Dialysis. In: American Journal of Medicine. 2017.
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T1 - Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Patients on Maintenance Dialysis

AU - Alqahtani, Fahad

AU - Aljohani, Sami

AU - Boobes, Khaled

AU - Maor, Elad

AU - Sherieh, Assem

AU - Rihal, Charanjit

AU - Holmes, David

AU - Alkhouli, Mohamad

PY - 2017

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N2 - Background: The introduction of transcatheter aortic valve replacement (TAVR) expanded definitive therapy of aortic stenosis to many high-risk patients, but it has not been fully evaluated in the dialysis population. We aimed to evaluate the current trend and in-hospital outcome of surgical aortic valve replacement (SAVR) and TAVR in the dialysis population. Methods: Severe aortic stenosis patients on maintenance dialysis who underwent SAVR or TAVR in the Nationwide Inpatient Sample database from January 1, 2005, through December 31, 2014, were included in our comparative analysis. The trends of SAVR and TAVR were assessed. In-hospital mortality, rates of major adverse events, hospital length of stay, cost of care, and intermediate care facility utilization were compared between the 2 groups using both unadjusted and propensity-matched data. Results: Utilization of aortic valve replacement in dialysis patients increased 3-fold; a total of 2531 dialysis patients who underwent either SAVR (n = 2264) or TAVR (n = 267) between 2005 and 2014 were identified. Propensity score matching yielded 197 matched pairs. After matching, a 2-fold increase in in-hospital mortality was found with SAVR compared with TAVR (13.7% vs 6.1%, P = .021). Patients who underwent TAVR had more permanent pacemaker implantation (13.2% vs 5.6%, P = .012) but less blood transfusion (43.7% vs 56.8%, P = .02). Rates of other key morbidities were similar. Hospital length of stay (19 ± 16 vs 11 ± 11 days, P <.001) and non-home discharges (44.7% vs 31.5%, P = .002) were significantly higher with SAVR. Cost of hospitalization was 25% less with TAVR. Conclusion: In patients on maintenance dialysis, TAVR is associated with lower hospital mortality, resource utilization, and cost in comparison with SAVR.

AB - Background: The introduction of transcatheter aortic valve replacement (TAVR) expanded definitive therapy of aortic stenosis to many high-risk patients, but it has not been fully evaluated in the dialysis population. We aimed to evaluate the current trend and in-hospital outcome of surgical aortic valve replacement (SAVR) and TAVR in the dialysis population. Methods: Severe aortic stenosis patients on maintenance dialysis who underwent SAVR or TAVR in the Nationwide Inpatient Sample database from January 1, 2005, through December 31, 2014, were included in our comparative analysis. The trends of SAVR and TAVR were assessed. In-hospital mortality, rates of major adverse events, hospital length of stay, cost of care, and intermediate care facility utilization were compared between the 2 groups using both unadjusted and propensity-matched data. Results: Utilization of aortic valve replacement in dialysis patients increased 3-fold; a total of 2531 dialysis patients who underwent either SAVR (n = 2264) or TAVR (n = 267) between 2005 and 2014 were identified. Propensity score matching yielded 197 matched pairs. After matching, a 2-fold increase in in-hospital mortality was found with SAVR compared with TAVR (13.7% vs 6.1%, P = .021). Patients who underwent TAVR had more permanent pacemaker implantation (13.2% vs 5.6%, P = .012) but less blood transfusion (43.7% vs 56.8%, P = .02). Rates of other key morbidities were similar. Hospital length of stay (19 ± 16 vs 11 ± 11 days, P <.001) and non-home discharges (44.7% vs 31.5%, P = .002) were significantly higher with SAVR. Cost of hospitalization was 25% less with TAVR. Conclusion: In patients on maintenance dialysis, TAVR is associated with lower hospital mortality, resource utilization, and cost in comparison with SAVR.

KW - Aortic stenosis

KW - Comparative outcomes

KW - Dialysis

KW - Surgical aortic valve replacement

KW - Transcatheter aortic valve replacement

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