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Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve

Andres M Pineda1, J Kevin Harrison2, Neal S Kleiman3

  • 1Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|October 21, 2018
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) shows better outcomes than surgical aortic valve replacement (SAVR) for high-risk patients with moderate/severe chronic kidney disease (CKD). Worsening CKD increases mortality and adverse events in TAVR patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • The impact of chronic kidney disease (CKD) on mid-term outcomes for patients undergoing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) remains unclear.
  • CKD affects a significant proportion of patients undergoing aortic valve replacement procedures.

Purpose of the Study:

  • To assess the 3-year clinical outcomes of TAVR compared to SAVR in patients stratified by CKD status.
  • To evaluate the impact of baseline CKD severity on outcomes in patients undergoing TAVR.

Main Methods:

  • Retrospective analysis of patients randomized to TAVR or SAVR in the CoreValve US Pivotal High Risk Trial.
  • Patients were stratified by estimated glomerular filtration rate (eGFR) into none/mild and moderate/severe CKD groups.
  • Primary endpoint was major adverse cardiovascular and renal events (MACRE), a composite of mortality, myocardial infarction, stroke/TIA, and new dialysis requirement.

Main Results:

  • Moderate/severe CKD was present in over 60% of high-risk patients in both TAVR and SAVR groups.
  • Among high-risk patients with moderate/severe CKD, TAVR showed a significantly lower 3-year MACRE rate (42.1%) compared to SAVR (51.0%, P=.04).
  • Worsening baseline CKD severity was associated with increased 3-year MACRE rates in TAVR patients (none/mild: 51.5%, moderate: 54.5%, severe: 63.1%, P=.001).

Conclusions:

  • TAVR demonstrates superior 3-year clinical outcomes compared to SAVR in high-risk patients with moderate/severe CKD.
  • Progressive CKD is linked to increased mid-term mortality and MACRE in patients treated with TAVR.
  • Further randomized trials are warranted to confirm optimal treatment strategies for complex patients with moderate-to-severe CKD.
Abstract

Keywords:
SAVRTAVRaortic stenosisrenal disease

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