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

Molly Szerlip, Alan Zajarias, Sreekanth Vemalapalli, Matthew Brennan, Dadi Dai, Hersh Maniar, Brian R. Lindman, Ralph Brindis, John D. Carroll, Mohanad Hamandi, Fred H. Edwards, Fred Grover, Sean O'Brien, Eric Peterson, John S. Rumsfeld, Dave Shahian, E. Murat Tuzcu, David Holmes, Vinod H. Thourani, Michael Mack

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2806-2815
Number of pages10
JournalJournal of the American College of Cardiology
Volume73
Issue number22
DOIs
StatePublished - Jun 11 2019

Fingerprint

Chronic Kidney Failure
Dialysis
Hospital Mortality
Transcatheter Aortic Valve Replacement
Blood Vessels
Mortality
Hemorrhage
Aortic Valve Stenosis
Aortic Valve
Surgical Instruments
Registries
Comorbidity
Thorax
Odds Ratio
Demography
Kidney
Survival

Keywords

  • aortic stenosis
  • end-stage renal disease
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Szerlip, M., Zajarias, A., Vemalapalli, S., Brennan, M., Dai, D., Maniar, H., ... Mack, M. (2019). Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease. Journal of the American College of Cardiology, 73(22), 2806-2815. https://doi.org/10.1016/j.jacc.2019.03.496

Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease. / Szerlip, Molly; Zajarias, Alan; Vemalapalli, Sreekanth; Brennan, Matthew; Dai, Dadi; Maniar, Hersh; Lindman, Brian R.; Brindis, Ralph; Carroll, John D.; Hamandi, Mohanad; Edwards, Fred H.; Grover, Fred; O'Brien, Sean; Peterson, Eric; Rumsfeld, John S.; Shahian, Dave; Tuzcu, E. Murat; Holmes, David; Thourani, Vinod H.; Mack, Michael.

In: Journal of the American College of Cardiology, Vol. 73, No. 22, 11.06.2019, p. 2806-2815.

Research output: Contribution to journalArticle

Szerlip, M, Zajarias, A, Vemalapalli, S, Brennan, M, Dai, D, Maniar, H, Lindman, BR, Brindis, R, Carroll, JD, Hamandi, M, Edwards, FH, Grover, F, O'Brien, S, Peterson, E, Rumsfeld, JS, Shahian, D, Tuzcu, EM, Holmes, D, Thourani, VH & Mack, M 2019, 'Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease', Journal of the American College of Cardiology, vol. 73, no. 22, pp. 2806-2815. https://doi.org/10.1016/j.jacc.2019.03.496
Szerlip, Molly ; Zajarias, Alan ; Vemalapalli, Sreekanth ; Brennan, Matthew ; Dai, Dadi ; Maniar, Hersh ; Lindman, Brian R. ; Brindis, Ralph ; Carroll, John D. ; Hamandi, Mohanad ; Edwards, Fred H. ; Grover, Fred ; O'Brien, Sean ; Peterson, Eric ; Rumsfeld, John S. ; Shahian, Dave ; Tuzcu, E. Murat ; Holmes, David ; Thourani, Vinod H. ; Mack, Michael. / Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease. In: Journal of the American College of Cardiology. 2019 ; Vol. 73, No. 22. pp. 2806-2815.
@article{c0423d98cd8e48fab154dad71d32e281,
title = "Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease",
abstract = "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.",
keywords = "aortic stenosis, end-stage renal disease, transcatheter aortic valve replacement",
author = "Molly Szerlip and Alan Zajarias and Sreekanth Vemalapalli and Matthew Brennan and Dadi Dai and Hersh Maniar and Lindman, {Brian R.} and Ralph Brindis and Carroll, {John D.} and Mohanad Hamandi and Edwards, {Fred H.} and Fred Grover and Sean O'Brien and Eric Peterson and Rumsfeld, {John S.} and Dave Shahian and Tuzcu, {E. Murat} and David Holmes and Thourani, {Vinod H.} and Michael Mack",
year = "2019",
month = "6",
day = "11",
doi = "10.1016/j.jacc.2019.03.496",
language = "English (US)",
volume = "73",
pages = "2806--2815",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "22",

}

TY - JOUR

T1 - Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease

AU - Szerlip, Molly

AU - Zajarias, Alan

AU - Vemalapalli, Sreekanth

AU - Brennan, Matthew

AU - Dai, Dadi

AU - Maniar, Hersh

AU - Lindman, Brian R.

AU - Brindis, Ralph

AU - Carroll, John D.

AU - Hamandi, Mohanad

AU - Edwards, Fred H.

AU - Grover, Fred

AU - O'Brien, Sean

AU - Peterson, Eric

AU - Rumsfeld, John S.

AU - Shahian, Dave

AU - Tuzcu, E. Murat

AU - Holmes, David

AU - Thourani, Vinod H.

AU - Mack, Michael

PY - 2019/6/11

Y1 - 2019/6/11

N2 - 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.

AB - 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.

KW - aortic stenosis

KW - end-stage renal disease

KW - transcatheter aortic valve replacement

UR - http://www.scopus.com/inward/record.url?scp=85065915936&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065915936&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2019.03.496

DO - 10.1016/j.jacc.2019.03.496

M3 - Article

C2 - 31171086

AN - SCOPUS:85065915936

VL - 73

SP - 2806

EP - 2815

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 22

ER -