Key result
End-stage renal disease and CKD accelerated bioprosthetic aortic stenosis progression compared to normal renal function, with greater annual declines in dimensionless index (-0.10 and -0.040 vs 0.025).
Why the study?
Renal disease can accelerate aortic stenosis progression, but there are limited case report data investigating its impact on prosthetic aortic valve stenosis.
Does renal disease accelerate the progression of bioprosthetic aortic stenosis in patients with bioprosthetic aortic valves?
Observational (n=115)
Does renal disease accelerate the progression of bioprosthetic aortic stenosis in patients with bioprosthetic aortic valves?
Patients with chronic kidney disease and end-stage renal disease experience an accelerated rate of bioprosthetic aortic valve stenosis progression compared to those with normal renal function.
Background Renal disease can lead to more rapid progression of aortic stenosis. However, there are limited case report data investigating the impact of renal disease on the rate of prosthetic aortic valve stenosis. We sought to quantify the rate of progression of bioprosthetic aortic stenosis in patients with renal disease. Methods Patients with bioprosthetic aortic valves and at least two transthoracic echocardiograms six or more months apart were included. Echocardiographic data from patients with end‐stage renal disease (ESRD), chronic kidney disease (CKD) stages 3–4, and normal renal function were compared using ANOVA and Kruskal‐Wallis tests. Results One hundred fifteen patients (43 ESRD, 52 CKD, and 20 controls) were included in this study. Changes in dimensionless index (DI) (units/year) for patients with normal renal function, CKD, and ESRD were .025 ± .13, −.040 ± .08, −.10 ± .13, respectively, leading to calculated changes in aortic valve area (AVA) (cm2/year) of .04 ± .28, −.13 ± .29, −.42 ± .72, respectively. Change in peak gradient (m/sec/year) was significantly lower for patients with normal renal function compared to ESRD; −.077 ± 5.98 versus 7.18 ± 17.9. In the ESRD group, a nonsignificant trend toward greater change in DI/year was seen in TAVR compared to SAVR: −.14 ± .16 versus −.08 ± .11. Conclusion Our results confirm limited available data reporting an accelerated rate of bioprosthetic stenosis in patients with CKD and ESRD. These data not only quantify this progression but may also inform clinical decision‐making and valve selection in patients with renal disease.
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Penmetsa et al. (2022) conducted an observational in Bioprosthetic aortic stenosis (n=115). Renal disease (ESRD and CKD) vs. Normal renal function was evaluated on Rate of progression of bioprosthetic aortic stenosis (change in dimensionless index, aortic valve area, and peak gradient). End-stage renal disease and CKD accelerated bioprosthetic aortic stenosis progression compared to normal renal function, with greater annual declines in dimensionless index (-0.10 and -0.040 vs 0.025).
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