End‐stage renal disease and severe aortic stenosis: Does valve replacement improve one‐year outcomes?

• Published in: Catheterization and cardiovascular interventions 2017-05, Vol.89 (6), p.1109-1115
• Main Authors: Condado, Jose F., Maini, Aneel, Leshnower, Bradley, Thourani, Vinod, Forcillo, Jessica, Devireddy, Chandan, Mavromatis, Kreton, Sarin, Eric L., Stewart, James, Guyton, Robert, Simone, Amy, Keegan, Patricia, Lerakis, Stamatios, Block, Peter C., Babaliaros, Vasilis
• Format: Article
• Language: English
• Subjects: Aged; Aortic stenosis; Aortic valve; aortic valve replacement; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Balloon Valvuloplasty - adverse effects; Balloon Valvuloplasty - mortality; Dialysis; End-stage renal disease; end‐stage renal disease on dialysis; Female; Fibrillation; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Humans; Kaplan-Meier Estimate; Kidney diseases; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Kidney transplantation; Male; Middle Aged; Mortality; Patient Selection; Proportional Hazards Models; Renal Dialysis; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Stenosis; Stroke; Survival; Survival analysis; Time Factors; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26875

Background Treatment for patients with end‐stage renal disease (ESRD) and severe aortic stenosis (AS) includes balloon aortic valvuloplasty (BAV), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement. We compared outcomes among these strategies. Methods A retrospective review of patients with ESRD undergoing treatment for severe AS between 07/2007 and 06/2015 was performed at our center. Patients were classified based on treatment: BAV‐only, TAVR, or SAVR. Baseline characteristics and 30‐day outcomes were compared among groups. A 1‐year survival analysis was performed. Results Of 85 patients, 25 (29.4%) underwent BAV, 30 (35.3%) TAVR, and 30 (35.3%) SAVR. Patients in the SAVR group, compared to the BAV or TAVR patients, were younger (63 vs. 74 vs. 71 years, P = 0.02) and had less prior stroke (3.3% vs. 12.0% vs. 30.0%, P = 0.008). While all BAV patients had NYHA class III/IV, 93.3% and 76.7% of patients had NYHA class III/IV in the TAVR and SAVR group, respectively (P = 0.001). BAV patients were less likely to have atrial fibrillation than TAVR or SAVR patients (16.0% vs. 43.3% vs. 50.0%, P = 0.03). All patients were high risk, but there was a statistical trend to lower STS scores in the SAVR group (8.6% vs. 13.5% vs. 13.5%, P = 0.08). There was no significant difference in 30‐day mortality (16.7% vs. 10.0% vs. 10.0%, P = 0.74), but BAV treated patients had an increased 1‐year mortality compared to those treated with TAVR or SAVR (87.0% vs. 32.0%, vs. 36.7%, P=