Outcomes of hemodialysis patients undergoing contemporary transcatheter aortic valve implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) is a viable alternative to surgery for hemodialysis patients. Purpose This study aimed to compare outcomes of contemporary TAVI in hemodialysis versus non-dialysis patients and stratify all-cause mortality. Methods 336 hemodialysis patients (11.6%) and 2,552 non-dialysis patients (88.4%) undergoing TAVI (2021–2024) were analyzed. The primary endpoint was all-cause mortality, with a median follow-up of 527 days. Results Hemodialysis patients were younger (81 vs. 85 years), mostly male, and had more comorbidities. Thirty-day mortality (2.9% vs. 1.5%) and procedural complications were similar. However, 1- and 2- year all-cause mortality rates were significantly higher in hemodialysis patients (14.4% vs. 6.5%; 21.5% vs. 11.0%, respectively). After adjusting for confounders, the effect of hemodialysis on mortality and composite outcomes disappeared. Independent predictors of mortality in hemodialysis patients included body mass index, Clinical Frailty Scale, and albumin level, enabling risk stratification into low, intermediate, and high-risk groups. Conclusion Among 2,888 patients undergoing TAVI between 2021 and 2024, 11.6% were on hemodialysis. Hemodialysis patients were younger and had more comorbidities with high surgical risk. Thirty-day outcomes, including death and major complications, were similar. While all-cause mortality was significantly higher, comorbidities, not hemodialysis, were the reason for worse outcomes.Abstract picture