Author + information
- Received November 14, 2018
- Revision received February 12, 2019
- Accepted March 5, 2019
- Published online June 3, 2019.
- Molly Szerlip, MDa,∗∗ (, )
- Alan Zajarias, MDb,∗,
- Sreekanth Vemalapalli, MDc,
- Matthew Brennan, MDc,
- Dadi Dai, PhDc,
- Hersh Maniar, MDb,
- Brian R. Lindman, MDd,
- Ralph Brindis, MDe,
- John D. Carroll, MDf,
- Mohanad Hamandi, MDa,
- Fred H. Edwards, MDg,
- Fred Grover, MDf,
- Sean O’Brien, PhDc,
- Eric Peterson, MDc,
- John S. Rumsfeld, MD, PhDf,
- Dave Shahian, MDh,
- E. Murat Tuzcu, MDi,
- David Holmes, MDj,
- Vinod H. Thourani, MDk and
- Michael Mack, MDa
- aBaylor Scott and White Health, Plano, Texas
- bWashington University School of Medicine, St. Louis, Missouri
- cDuke University School of Medicine, Durham, North Carolina
- dVanderbilt University School of Medicine, Nashville, Tennessee
- eUniversity of California School of Medicine, San Francisco, California
- fUniversity of Colorado School of Medicine, Denver, Colorado
- gUniversity of Florida School of Medicine, Jacksonville, Florida
- hHarvard Medical School, Boston, Massachusetts
- iCleveland Clinic Foundation, Cleveland, Ohio
- jMayo Clinic, Rochester, Minnesota
- kMedStar Heart and Vascular Institute and Georgetown University School of Medicine, Washington, DC
- ↵∗Address for correspondence:
Dr. Molly Szerlip, 4716 Alliance Boulevard, Pavilion 2, Suite 340, Plano, Texas 75093.
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.
↵∗ Drs. Szerlip and Zajarias contributed equally to this work and are co-first authors.
Dr. Szerlip has served as a speaker for Edwards Lifesciences and Medtronic. Dr. Zajarias has served as a consultant to Edwards, Abott, and Boston Scientific; and has received research support from Medtronic, Edwards, Boston Scientific, and Abbott. Dr. Vemulapalli has received grants from the American College of Cardiology (ACC), the Society of Thoracic Surgeons, Abbott Vascular, PCORI, and Boston Scientific; has served as a consultant and/or on the Advisory Board for Boston Scientific, Novella, and Janssen; and has served as a consultant for Zafgen and Premiere. Dr. Brennan has served as a consultant for Edwards Lifesciences. Dr. Lindman has received investigator-initiated research grants from Edwards Lifesciences and Roche Diagnostics; has received a research grant from Medtronic; and has served as a consultant for Roche Diagnostics. Dr. Carroll has served as an investigator for the Medtronic Low Risk TAVR Trial and Edwards PARTNER 2 Trial. Dr. Grover has served as a consultant for JenaValve. Dr. Shahian has served on ACC/STS TVT-related working groups (uncompensated). Dr. Peterson has served as co-investigator for the TAVR Registry analytic center at DCRI. Dr. Rumsfeld has served as Chief Innovative Officer for the American College of Cardiology. Dr. Brindis has served as Senior Medical Officer for the ACC-NCDR. Dr. Thourani has served as an advisor to Edwards Lifesciences, Boston Scientific, Abbott Vascular, Gore Vascular, and JenaValve. Dr. Mack has served as co-principal investigator for the Edwards Lifesciences PARTNER trial and Abbott COAPT Trial; and has served as study chair for the Medtronic APOLLO Trial. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received November 14, 2018.
- Revision received February 12, 2019.
- Accepted March 5, 2019.
- 2019 American College of Cardiology Foundation
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