Key result
In hemodialysis patients undergoing TAVR, estimated median survival was 1.8 years, with 30-day and 1-year survival rates of 83.3% and 68.3%, respectively.
Why the study?
Patients on hemodialysis have high perioperative mortality and poor long-term survival with SAVR, but limited information is available on outcomes following TAVR in this population.
Cohort (n=42)
No
In hemodialysis patients undergoing TAVR, median survival is less than two years, with predominantly bleeding events contributing to perioperative morbidity.
Short survival after TAVR in hemodialysis patients warrants cautious selection; leaves open benefit versus alternatives in randomized trials.
BACKGROUND: Perioperative mortality is high and long-term survival is poor for patients on hemodialysis undergoing surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) offers a safe and effective therapy for high-risk patients suffering from aortic valve stenosis. However, in patients on hemodialysis only limited information is available on the outcome following TAVR. METHODS: Of the 2613 consecutive patients in our single-center TAVR registry, all hemodialysis patients, were identified. Demographics, procedural details, clinical outcomes, mortality, and complications were evaluated. RESULTS: Forty-two hemodialysis patients with a mean age of 75.2±8.2 years, a mean STS predicted risk of mortality of 11.1±9.5% and a mean logEuroScore of 27.9±18.8% underwent TAVR. Mean duration on hemodialysis prior to intervention was 62.8±49.6 months. A transfemoral access was chosen in 24 patients, a transapical in 16, and a transaxillary and a transaortic in one patient, respectively. Estimated survival at 30 days, one, three and five years was 83.3%, 68.3%, 37.7% and 18.9%, respectively. Estimated median survival was 1.8±0.4 years. VARC-2 defined perioperative complications included stroke in 7.1% (3/42), major bleeding in 16.7% (7/42), and vascular complications in 7.1% (3/42). In two patients, echocardiographic examination at three and four years, respectively, showed evidence for structural valve deterioration. CONCLUSION: A high number of patients with ESRD undergoing TAVR require a non-transfemoral access. Predominantly, bleeding events contribute to the perioperative morbidity. An estimated median survival of less than two years after TAVR allows only limited assessment of valve prosthesis durability. Cardiovascular and non-cardiovascular mortality contribute equally to the causes of death beyond the first year after TAVR.
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Ruge et al. (2020) conducted a cohort in Aortic valve stenosis in patients on hemodialysis (n=42). Transcatheter aortic valve replacement (TAVR) was evaluated on Estimated median survival. In hemodialysis patients undergoing TAVR, estimated median survival was 1.8 years, with 30-day and 1-year survival rates of 83.3% and 68.3%, respectively.
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