Author + information
- Andres M. Pineda Maldonado,
- Nirat Beohar,
- J. Kevin Harrison,
- Neal Kleiman,
- Michael Reardon,
- John Conte,
- Daniel O'Hair,
- Stanley Chetcuti,
- Steven Yakubov and
- Jeffrey Popma
Background: The impact of preoperative renal dysfunction on the clinical outcomes after TAVR vs. SAVR is unclear.
Methods: Patients enrolled in the CoreValve US Pivotal High Risk Trial were divided by none/mild (Glomerular filtration rate [GFR] > 60mL/min/1.73m2), moderate (GFR 30-60), or severe (GFR < 30) preoperative renal dysfunction (PRD). The primary endpoint was the incidence of major adverse cardiovascular and renal events (MACRE); defined as all-cause mortality, myocardial infarction, stroke, and need for new renal replacement therapy.
Results: A total of 745 eligible patients (TAVR 389, SAVR 356) were included in this analysis. None/mild, moderate and severe PRD were present in 38.3, 56.6, and 5.1% of the patients, respectively. The 30-day MACRE increased as a function of PRD after both TAVR (none/mild 7.6%, moderate 9.3%, and severe 17.6%) and SAVR (none/mild 10.7%, moderate 11.8%, and severe 33.3%) (Figure). Patients with none/mild and moderate PRD had numerically reduced 1-year MACRE when treated with TAVR compared with SAVR (17.3 vs. 27.2%, p=0.05 and 20.7 vs. 27.6%, p=0.10, respectively). Similarly, there was a trend towards a reduced 3-year MACRE in TAVR patients with none/mild and moderate PRD (38.1 vs. 45.8%, p=0.12 and 40.8 vs. 48.9%, p=0.08, respectively).
Conclusions: The clinical outcomes after either SAVR or TAVR worsen as a function of the severity of PRD. However, TAVR may reduce major adverse events compared with SAVR in those with none to moderate preoperative renal dysfunction.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Cardiology: TAVR 2
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1195-178
- 2017 American College of Cardiology Foundation