Transcatheter aortic valve implantation in dialysis patients resulted in no 30-day mortality and similar 6-month survival compared to non-dialysis CKD patients (log-rank p=0.935).
Observational (n=155)
Is TAVI safe and effective in patients on chronic hemodialysis compared to non-dialysis CKD patients and compared to open surgical valve replacement?
TAVI appears to be a safe procedure for patients on chronic hemodialysis, offering an alternative to open surgery with comparable short-term survival to non-dialysis CKD patients.
p-value: p=0.935
BACKGROUND/AIMS: Transcatheter aortic valve implantation (TAVI) has emerged as a new therapeutic option for high-risk patients. However, dialysis patients were excluded from all previous studies. The aim of this study is to compare the outcomes of TAVI for dialysis patients with those for patients with chronic kidney disease (CKD) stages 3 and 4 and to compare TAVI with open surgery in dialysis patients. METHODS: Part I: comparison of 10 patients on chronic hemodialysis with 116 patients with non-dialysis-dependent CKD undergoing TAVI. Part II: comparison of transcatheter (n = 15) with open surgical (n = 24) aortic valve replacement in dialysis patients. RESULTS: Part I: dialysis patients were significantly younger (72.3 vs. 82.0 years; p < 0.01). Hospital stay was significantly longer in dialysis patients (21.8 vs. 12.1 days; p = 0.01). Overall 30-day mortality was 3.17%, with no deaths among dialysis patients. Six-month survival rates were similar (log-rank p = 0.935). Part II: patient age was comparable (66.5 vs. 69.5 years; p = 0.42). Patients in the surgical group tended to stay longer in hospital than TAVI patients (29.5 vs. 22.5 days; p = 0.35). CONCLUSION: TAVI is a safe procedure in patients on chronic hemodialysis. Until new data become available, we find no compelling reason to refuse these patients TAVI.
Rau et al. (Quarta-feira) conduziram um estudo observacional sobre a doença da válvula aórtica em pacientes em diálise e doença renal crônica (n=155). A implantação de válvula aórtica por cateter (TAVI) foi comparada ao tratamento cirúrgico aberto de substituição da válvula aórtica e pacientes com DRC não-dialíticos, avaliando a sobrevida em 6 meses (p=0,935). A implantação de válvula aórtica por cateter em pacientes em diálise não resultou em mortalidade de 30 dias e teve uma sobrevida em 6 meses semelhante à dos pacientes com DRC não-dialíticos (log-rank p=0,935).
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