One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease

Daniel P. O'Hair, Tanvir K. Bajwa, Stanley J. Chetcuti, G. Michael Deeb, Robert C. Stoler, Robert F. Hebeler, Brijeshwar Maini, Mubashir Mumtaz, Neal S. Kleiman, Michael J. Reardon, Shuzhen Li, David H. Adams, Daniel R. Watson, Steven J. Yakubov, Jeffrey J. Popma, George Petrossian

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Background End-stage renal disease (ESRD) poses unique challenges in the treatment of patients with severe aortic stenosis. Although surgical valve replacement in ESRD patients has been associated with increased mortality, the outcomes from transcatheter aortic valve replacement (TAVR) are not clearly defined. Methods The CoreValve US Expanded Use Study is a prospective, nonrandomized study of TAVR in extreme-risk patients with comorbidities excluding them from the Pivotal Trial. We report on patients with ESRD. The primary endpoint was a composite of all-cause mortality or major stroke at 1 year. Results Ninety-six patients with ESRD underwent TAVR with the CoreValve (Medtronic, Minneapolis, MN) and have reached 1-year follow-up. Mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 16.2% ± 8.4%. The rate of all-cause mortality or major stroke at 1 year was 30.3%. The all-cause mortality rate was 5.3% at 30 days and 30.3% at 1 year. The rate at 1 year of any stroke or transient ischemic attack was 2.1%; major vascular injury was 5.2%; and new permanent pacemaker was 26.8%. Valve performance improved postprocedure and remained improved at 1 year (effective orifice area 1.71 cm2, mean gradient 9.33 mm Hg) Conclusions Early mortality in patients with ESRD is comparable to previously published data on extreme-risk patients without ESRD, but our data suggest a higher mortality rate at 1 year for ESRD patients, likely due to comorbid conditions. Stroke and major vascular injury are infrequent, and improved valve hemodynamics are maintained at 1 year.

Original languageEnglish (US)
Pages (from-to)1392-1398
Number of pages7
JournalAnnals of Thoracic Surgery
Volume103
Issue number5
DOIs
StatePublished - May 2017

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease'. Together they form a unique fingerprint.

Cite this