The need for dialysis after TAVR increases mortality

Courtesy of Dr. Carlos Fava.

Stage III or higher renal impairment is frequent before TAVR, and the need for new dialysis after the procedure may reach up to 20%. Within that percentage, 5% may require permanent dialysis, which increases mortality up to 9 times at one year. In that sense, factors leading to that complication have not been well studied yet.

This study included prospectively 6464 patients from 2007 to 2014. Among them, 117 were subjected to dialysis before the procedure (1.8%) and 202 required dialysis after percutaneous valve implantation (3.1%). The follow-up was 625 days (268-1208).

There were no significant differences between populations, except for the fact that non-transfemoral access and Edwards valves were more frequent among patients requiring new dialysis.

Read also: “Post TAVR Dialysis: a Severe Complication Less and Less Frequent”.

The need for new dialysis ranged from 6.1% in 2007-2008 to 2.3% in 2013-2014. The need for new dialysis after TAVR was independently associated with renal impairment a year after the procedure, impaired left ventricular function, diabetes, use of an Edwards valve, a non-transfemoral approach, need for open surgery, and moderate-to-severe aortic regurgitation.

Furthermore, upon follow-up, this need was associated with increased 30-day mortality (hazard ratio [HR]: 6.44; 95% confidence interval [CI]: 4.87 to 8.53) and 4-year mortality (HR: 3.54; 95% CI: 2.99 to 4.19; p < 0.001), compared with patients who did not require dialysis.

Conclusion

The proportion of patients needing dialysis after TAVR has decreased over time. Post-TAVR dialysis was associated with increased mortality.

Editorial Comment

While it is widely known that the need for dialysis increases the rates of other complications and mortality for all endovascular and surgical procedures, this analysis shows that this complication decreases significantly as we move along the learning curve.

Read also: “A Simple Electrocardiography to Predict Mortality in TAVR”.

On the other hand, we must remain alert to comorbidities and use the lowest possible contrast to reduce the incidence of this unpleasant complication.

Courtesy of Dr. Carlos Fava.

Original title: Dialysis Following Transcatheter Aortic Valve Implantation, Risk Factors and Outcomes. An Analisis From the UK TAVI Registry.

Reference: Charles Ferro, et al. J Am Coll Cardiol Intevn Article in Press.

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