Key result
In-hospital mortality trends remained stable for TAVR in chronic dialysis patients (aOR 0.92; 95% CI 0.79-1.07) but increased significantly for SAVR (aOR 1.14; 95% CI 1.05-1.25).
Why the study?
Trends of utilization and outcomes of TAVR and SAVR for patients on chronic dialysis were not well described.
How do the trends in utilization and outcomes (in-hospital mortality and 30-day readmission) compare between TAVR and SAVR in patients on chronic dialysis?
Observational (n=12,222)
Yes
How do the trends in utilization and outcomes (in-hospital mortality and 30-day readmission) compare between TAVR and SAVR in patients on chronic dialysis?
Odds Ratio: 0.92 (95% CI 0.79–1.07)
p-value: p=.23
TAVR utilization has surpassed SAVR in patients on chronic dialysis, with stable in-hospital mortality trends for TAVR compared to worsening trends for SAVR, though outcomes remain worse than in non-dialysis patients.
Rising TAVR use in dialysis patients signals need for vigilant outcome tracking; leaves open whether refined selection improves results.
BACKGROUND AND AIM: Trends of utilization and outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) for patients on chronic dialysis (CD) are not well described. We aimed to assess the trends in utilization and outcomes of TAVR and SAVR on CD. METHODS: Nationwide Readmission Databases from 2013 to 2017 was analyzed. International Classification of Diseases Clinical Modification 9 and 10 codes were used to identify diagnoses and procedures. A multivariable regression model was used to compare the outcomes expressed as adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS: A total of 5731 TAVR and 6491 SAVR were performed in patients with CD, respectively. The volume of TAVR increased by approximately four-folds and SAVR increased by approximately 33%. However, amongst patients with CD, the percentage of TAVR increased, whereas that of SAVR decreased (p < .001 for all). In 2016 and 2017, TAVR volume surpassed that of SAVR on CD. In-hospital mortality remained similar in TAVR (aOR: 0.92; 95% CI: 0.79-1.07; p-trend = .23) whereas it increased significantly in SAVR (aOR: 1.14: 95% CI: 1.05-1.25, p-trend = .002). In 2017, in-hospital mortality and 30-day readmission were significantly higher in TAVR among CD than non-CD patients. CONCLUSION: Despite increased use of TAVR among CD, there still is an opportunity for improvement in outcome of aortic valve replacement for those on CD.
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Ando et al. (2020) conducted an observational in chronic dialysis requiring aortic valve replacement (n=12,222). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on In-hospital mortality trend (aOR 0.92, 95% CI 0.79-1.07, p=.23). In-hospital mortality trends remained stable for TAVR in chronic dialysis patients (aOR 0.92; 95% CI 0.79-1.07) but increased significantly for SAVR (aOR 1.14; 95% CI 1.05-1.25).
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