Patients undergoing TAVR who have end-stage renal disease (ESRD) and are dialysis-dependent may have a higher risk of mortality than patients who are not dependent on dialysis, according to a study published June 3 in the Journal of the American College of Cardiology.

Using data from the STS/ACC TVT Registry, Molly Szerlip, MD, FACC, et al., looked at 72,631 patients with severe aortic stenosis treated with TAVR, and compared in-hospital and one-year outcomes in ESRD vs. nondialysis patients.

Overall, patients with ESRD were younger than nondialysis patients (78 years vs. 84 years), more likely to be male (58.3 percent vs. 48.5 percent), and more likely to be African American (11.4 percent vs. 3.3 percent). ESRD patients also had higher rates of peripheral arterial disease, hypertension, diabetes, previous myocardial infarction and heart failure symptoms. There was no difference in previous coronary revascularization, stroke or atrial fibrillation between the two groups.

The ESRD group had a higher rate of complications and a longer average stay in the intensive care unit (six days vs. five days). In addition, the ESRD group had a higher rate of in-hospital mortality (5.1 percent vs. 3.4 percent) and major bleeding (1.4 percent vs. 1 percent), but the two groups had similar rates of major vascular complications (4.5 percent for ESRD patients vs. 4.6 percent for nondialysis patients). The one-year mortality rate was significantly higher in ESRD patients (36.8 percent), compared with nondialysis patients (18.7 percent).

According to the researchers, the study's findings that ESRD is associated with increased mortality at 30 days and one year in TAVR patients have "important potential implications in patient selection, and therefore, careful patient selection to optimize use of this procedural resource is necessary."

In an accompanying editorial comment, George Bayliss, MD, explains that "TAVR is a high-risk procedure for anyone with ESRD on dialysis or even approaching the need for dialysis." He adds that moving forward, more research is needed to identify ESRD patients with aortic stenosis who would benefit from TAVR and that the "procedure carries high risk and may, at best, only buy a little more time" even for carefully selected patients.

Keywords: Hospital Mortality, Atrial Fibrillation, Renal Dialysis, Transcatheter Aortic Valve Replacement, Patient Selection, Peripheral Arterial Disease, Aortic Valve Stenosis, Stroke, Kidney Failure, Chronic, Myocardial Infarction, Registries, National Cardiovascular Data Registries, STS/ACC TVT Registry, Diabetes Mellitus, Heart Failure, Hypertension

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