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July 3, 2023Open Access

In-Hospital Outcomes of Transcatheter Aortic Valve Replacement in Patients with Chronic and End-Stage Renal Disease: A Nationwide Database Study

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Why the study?

With TAVR indications expanding, the current implications of chronic renal insufficiency, CKD, and ESRD on in-hospital outcomes after TAVR needed to be determined.

Does chronic kidney disease or end-stage renal disease increase in-hospital mortality and complications in patients undergoing TAVR?

Population

279,195 patients undergoing TAVR

Comparison

CKD vs ESRD vs normal renal function

Design

Nationwide retrospective database study

Follow-up

In-hospital

Authors

MLMarta Lorente‐RosSDSubrat DasAMAaqib H. Malik

Discussion

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Overview

May inform pre-TAVR risk stratification in CKD/ESRD; leaves open prospective trials on mitigation strategies.

Key Points

  • Determine the impact of chronic kidney disease (CKD) and end-stage renal disease (ESRD) on in-hospital mortality and clinical complications following transcatheter aortic valve replacement (TAVR).
  • Queried the National Inpatient Sample (2016–2020) using ICD-10 codes to identify patients undergoing TAVR (N=279,195).
  • Categorized patients by kidney function into normal renal function (67.1%), CKD (29.2%), and ESRD (3.7%).
  • Analyzed in-hospital mortality and adverse outcomes using multivariable logistic regression adjusted for baseline comorbidities, using normal renal function as reference.
  • Overall in-hospital mortality was 1.3%, with significantly higher risk observed in CKD (adjusted OR: 1.4, 95% CI: 1.2–1.7) and ESRD (adjusted OR: 2.4, 95% CI: 1.8–3.3) compared to normal renal function.
  • Renal insufficiency was associated with elevated rates of cardiogenic shock, vascular access complications, mechanical circulatory support, and post-procedural infections and respiratory complications.
  • Patients with ESRD had a higher risk of periprocedural acute myocardial infarction and cardiac arrest, whereas conversion to open-heart surgery occurred in 0.3% of cases and did not differ across groups.

Structured PICO

Does chronic kidney disease or end-stage renal disease increase in-hospital mortality and complications in patients undergoing TAVR?

P
Population
279,195 adults (aged ≥ 18 years) who underwent transcatheter aortic valve replacement (TAVR) in the United States between 2016 and 2020, mean age 78.9, 44.4% female.
I
Intervention
Transcatheter aortic valve replacement (TAVR) in patients with chronic kidney disease (CKD, n=81,640) or end-stage renal disease (ESRD, n=10,230).
C
Comparator
Transcatheter aortic valve replacement (TAVR) in patients with normal renal function (n=187,325).
O
Outcome
In-hospital all-cause mortality.hard clinical

Patients with chronic kidney disease and end-stage renal disease undergoing TAVR have a significantly higher risk of in-hospital mortality and periprocedural complications compared to those with normal renal function, emphasizing the need for individualized patient selection.

Limitations

  • Retrospective nature limits conclusions to in-hospital outcomes.
  • Administrative claim-based database precluded study of post-procedural embolic stroke and permanent pacemaker implantation.
  • Database does not include information on specific indication for TAVR or type of device used.
  • No stratification of patients by surgical risk.

Cite This Study

Lorente‐Ros et al. (2023) studied this question.

synapsesocial.com/papers/6a7614a78802f13c0e613beahttps://doi.org/10.21203/rs.3.rs-2992812/v1
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Long‐Term Outcomes of Transcatheter Aortic Valve Replacement in Patients With End‐Stage Renal Disease2021 · 29 citations
  2. 2Acute kidney injury post–transcatheter aortic valve replacement2017 · 66 citations
  3. 3Non-contrast transoesophageal echo-guided transapical transcatheter aortic valve replacement: 10-year experience of a renoprotective strategy2021 · 7 citations
  4. 4General Versus Local Anesthesia With Conscious Sedation in Transcatheter Aortic Valve Implantation2020 · 164 citations
  5. 5Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients2019 · 4,902 citations