Related Experiment Video
Updated: Feb 22, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Comparative Outcomes of Patients With Advanced Renal Dysfunction Undergoing Transcatheter Aortic Valve Replacement in
Divyanshu Mohananey1, Brian P Griffin1, Lars G Svensson1
1From the Heart and Vascular Institute, Cleveland Clinic, OH.
Insights
Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) undergoing transcatheter aortic valve replacement face higher in-hospital mortality and adverse events. This highlights the critical impact of renal function on TAVR outcomes.
Area of Science:
- Cardiology
- Nephrology
- Health Services Research
Background:
- Renal dysfunction is common in patients undergoing transcatheter aortic valve replacement (TAVR), affecting over 25%.
- The outcomes for patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) undergoing TAVR are not well-established.
Purpose of the Study:
- To compare in-hospital outcomes of TAVR patients with CKD or ESRD versus those without renal impairment.
- To evaluate the impact of CKD and ESRD on mortality and adverse events after TAVR.
Main Methods:
- Utilized the National Inpatient Sample database (2011-2014).
- Identified TAVR patients using ICD-9-CM procedure codes 350.5 and 350.6.
- Compared in-hospital mortality, length of stay, hemorrhage, and pacemaker implantation rates across patient groups.
Main Results:
- Analyzed 42,189 TAVR patients: 62.1% no CKD/ESRD, 33.7% CKD, 4% ESRD.
- Patients with CKD or ESRD experienced significantly higher in-hospital mortality (P<0.001).
- CKD/ESRD patients had longer hospital stays, increased hemorrhage requiring transfusion, and higher rates of permanent pacemaker implantation (P<0.001).
Conclusions:
- CKD and ESRD are associated with increased in-hospital mortality following TAVR.
- Patients with CKD/ESRD face greater periprocedural adverse events and extended hospital stays compared to non-CKD patients.
- These findings underscore the importance of considering renal function in TAVR patient management and risk stratification.
Background:
Renal dysfunction is intricately linked to aortic stenosis, with over 25% patients presenting for transcatheter aortic valve replacement having chronic kidney disease (CKD). Prevalence and outcomes of patients with CKD, especially those with end-stage renal disease (ESRD), are controversial. We aimed to compare in-hospital outcomes of patients with CKD or ESRD with those patients with no CKD/ESRD.
Methods And Results:
Data were obtained using the national inpatient sample between the years 2011 and 2014. We used the International Classification of Diseases, Ninth Edition, Clinical Modification procedure codes 350.5 and 350.6 to identify patients undergoing transcatheter aortic valve replacement. Primary outcome of interest was in-hospital mortality. A 2-tailed P value <0.01 was considered to denote statistical significance for all analyses. We identified 42 189 patients who underwent transcatheter aortic valve replacement between the years 2011 and 2014. Of these, 62.1% (n=26 229) had no CKD/ESRD, 33.7% (n=14 252) had CKD, and 4% (n=1708) had ESRD. Patients with CKD or ESRD had greater in-hospital mortality, hospital length of stay, hemorrhage requiring transfusion, and permanent pacemaker implantation (P<0.001).
Conclusions:
Patients with CKD and ESRD have increased in-hospital mortality and periprocedural adverse events with longer hospital length of stay, when compared with those without CKD.
