TCT-842 Transcatheter Aortic Valve Replacement in ESRD: Short- and Long-Term Outcomes, Valve Degeneration, and Reintervention Rates in Propensity-Matched Analysis

Document Type

Conference Proceeding

Publication Date

10-29-2024

Publication Title

J Am Coll Cardiol

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has shown a clear benefit in patients with symptomatic, severe aortic stenosis (AS), yet there is a paucity of data on end-stage renal disease (ESRD) patients. Methods: This retrospective single-center study at a quaternary valve center evaluated the outcomes of ESRD patients undergoing TAVR from 2012-present. We first analyzed rates of major adverse cardiac event (MACE) outcomes, structural valve degeneration (SVD), and structural valve reintervention (SVR) for all ESRD patients (unadjusted cohort). We then performed propensity matching to compare a subset of ESRD patients (adjusted cohort) with non-ESRD chronic kidney disease (CKD) patients. Preoperative risk was determined using the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM). Results: The unadjusted ESRD cohort of 95 patients demonstrated high preoperative risk (9.67%) with correlating high MACE outcome rates during the index hospitalization. At long-term follow-up, the SVD and SVR rates were 26.3% and 3.2%, respectively. There was no correlation between preoperative risk and time to SVD. After propensity matching the adjusted cohorts for preoperative risk (ESRD 7.63% and non-ESRD CKD 7.67%), a total of 54 patients were included in this subanalysis. These ESRD patients demonstrated a nonsignificant trend toward higher death rates during the index hospitalization (P = 0.09), as well as significantly higher MACE outcomes (P < 0.01) and bleeding events (P = 0.02). At the 1-year follow-up period, death (P = 0.03), MACE (P < 0.01), and SVD rates (0.04) were significantly higher in the ESRD cohort. No SVR was reported in either matched cohort. [Formula presented] Conclusion: In those undergoing TAVR, ESRD patients are at higher risk of MACE outcomes and SVD than non-ESRD CKD patients. Despite this, rates of SVR are low. This study helps risk stratify ESRD patients considered for TAVR and prognosticate post-TAVR valve outcomes in both the short-term and long-term follow-up period. Categories: STRUCTURAL: Valvular Disease: Aortic.

Volume

84

Issue

18

First Page

B346

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