Aortic Stenosis and Dialysis: Is TAVR the Strategy of Choice?

Courtesy of Dr. Carlos Fava.

TAVR has been shown beneficial in high and moderate risk patients, but there is a group of patients that require dialysis on account of kidney deterioration.  This comorbidity is due to bad cardiovascular evolution associated to diabetes, bleeding and thromboembolic events.

For some time, we have been using an aortic valve percutaneous replacement strategy in this group, but there is little evidence of its benefits compared against surgical replacement.

This study included 1025 patients: 328 (32%) received TAVR (69 patients via transapical access) and 697 surgical aortic valve replacement (SAVR).

Read also: Differences in Stroke between TAVR and SAVR in Intermediate Risk Patients.

TAVR patients were older (75.3 vs. 61.6 mean age, P<0.001) and higher comorbidities index, such as heart failure (16.2% vs. 7.5%, P<0.001), diabetes (28.4% vs. 22.5%, P 0.05) and chronic obstructive pulmonary disease (27.7% vs. 20.4% p0 0.05). Instead, those undergoing SAVR more often had coagulation disorders (41.6% vs. 28.4% p>0.05), and neurological compromise (10.9% vs. 6.7% p<0.05) and took more drugs (3% vs. 0.6% p<0.05).

Using propensity score, patient population was matched into 175 pairs.

In-hospital mortality was similar (8% for TAVR vs. 10.3% for SAVR p=0.58). Patients undergoing TAVR had shorter hospitalization (8 vs. 14 days p<0.001), lower hospital cost (U$S 276.488 vs. U$S 364.280 p =0.01), fewer in-hospital complications (60.6% vs. 76% p 0.003) higher home discharge (76% vs. 60.6% p 0.004), in addition to less need for transfusion and fewer breathing complications.

Conclusion

Regardless treatment mortality, severe aortic stenosis patients have higher in-hospital mortality. TAVR and SAVR presented similar in-hospital mortality but TAVR was associated to shorter hospitalization, lower hospitalization cost, less in-hospital complications and higher discharge.

Courtesy of Dr. Carlos Fava.

Original Title: In-hospital outcomes of transcatheter versus surgical aortic valve replacement in end stage renal disease.

Reference: Ahmad Alkhalil, et al. Cardiovasc Interv.  Catheter Cardiovasc Interv. 2018;92:757–765.

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