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Ann Thorac Surg. 2016 Aug;102(2):540-7. doi: 10.1016/j.athoracsur.2016.01.109. Epub 2016 Apr 26.

Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement for Severe Aortic Stenosis in Patients With Chronic Kidney Disease Stages 3b to 5.

Author information

1
National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
2
Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy.
3
National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. Electronic address: stefano.rosato@iss.it.
4
Department of Surgery, University of Oulu, Oulu, Finland.
5
Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
6
Division of Cardiac Surgery, IRCCS San Martino, University Hospital, Genova, Italy.
7
Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
8
Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy.
9
Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
10
Division of Cardiology, Careggi Hospital, Florence, Italy.
11
Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy.
12
Department of Epidemiology of Lazio Regional Health Service, Rome, Italy.

Abstract

BACKGROUND:

There are scarce data on outcomes after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in patients with renal failure.

METHODS:

We evaluated the impact of renal failure on outcomes after TAVI and SAVR and compared the results of these procedures in patients with chronic kidney disease stages 3b to 5 from the Observational Study of Effectiveness of AVR-TAVI Procedures for Severe Aortic Stenosis Treatment (OBSERVANT) study.

RESULTS:

Chronic kidney disease (CKD) stages 3b to 5 was associated with an increased risk of mortality after either TAVI or SAVR compared with CKD stages 1 to 3a. Among 170 propensity score-matched pairs with CKD stages 3b to 5, patients who underwent TAVI had a significantly higher rate of permanent pacemaker implantation, vascular damage, and mild to moderate paravalvular regurgitation, and tended to have a higher 30-day mortality (7.1% versus 2.9%; p = 0.09). Thirty-day mortality after transapical TAVI was 7.1%. SAVR had a significantly higher rate of blood transfusions, stroke, and acute kidney injury. At 2 years, patients undergoing TAVI had somewhat higher all-cause mortality (31.2% versus 23.4%; p = 0.118), major cardiac and cerebrovascular events (37.2% versus 31.0%; p = 0.270), and a lower risk of dialysis (12.4% versus 21.2%; p = 0.052) compared with SAVR.

CONCLUSIONS:

CKD stages 3b to 5 increases the risk of mortality after TAVI and SAVR. In this subset of patients, SAVR was associated with somewhat better early and late survival. The risk of acute kidney injury was higher after SAVR. These findings suggest that CKD stages 3b to 5 does not contraindicate SAVR. Strategies to prevent severe acute kidney injury should be implemented with either SAVR or TAVI.

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