Structural Valve Deterioration in End-Stage Renal Disease Patients With Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis (AS), particularly for high-risk and inoperable populations. Nevertheless, patients with end-stage renal disease (ESRD) who require TAVR present a unique clinical challenge. These patients tend to have a high burden of comorbidities, as well as chronic uremia, that purportedly predispose them to a higher risk of more frequent and rapid structural valve deterioration (SVD). This narrative review synthesizes contemporary evidence regarding the mechanisms, incidence, and clinical outcomes of TAVR SVD in the ESRD population. In doing so, we summarize the pathophysiology for SVD in this patient population, contextualize the reported rates of TAVR SVD, and summarize the limited literature describing the clinical outcomes for these patients. We posit that clinical management for ESRD patients must focus on proactive, multidisciplinary surveillance and the integration of predictive modeling to optimize the timing of rescue interventions. Finally, we underscore the importance of better understanding the underlying mechanisms that accelerate TAVR SVD in uremic conditions.