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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

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Impact of bleeding after transcatheter aortic valve replacement in patients with chronic kidney disease

Shawn X Li1, Nilay K Patel1, Laura D Flannery1

  • 1Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|May 23, 2020
PubMed

Insights

Patients with chronic kidney disease (CKD) face increased bleeding risks after transcatheter aortic valve replacement (TAVR). This bleeding is linked to higher mortality, underscoring the need for careful management post-TAVR.

Area of Science:

  • Cardiology
  • Nephrology
  • Transcatheter Aortic Valve Replacement (TAVR)
  • Chronic Kidney Disease (CKD)

Background:

  • Patients with chronic kidney disease (CKD) exhibit elevated bleeding risks post-transcatheter aortic valve replacement (TAVR).
  • The persistence of bleeding risk beyond the immediate procedure and its impact on mortality in CKD patients undergoing TAVR remain unclear.
  • Understanding these risks is crucial for optimizing patient care and outcomes.

Purpose of the Study:

  • To investigate bleeding risks in patients with CKD undergoing TAVR.
  • To determine the association between post-TAVR bleeding and subsequent mortality in CKD patients.
  • To analyze antithrombotic therapy patterns in CKD patients post-TAVR.

Main Methods:

  • Retrospective review of TAVR patients at Massachusetts General Hospital (2008-2017).
  • CKD defined as estimated glomerular filtration rate < 60 mL/min/1.73 m².
  • Primary endpoints included bleeding, all-cause mortality, and ischemic stroke up to 1 year post-TAVR, analyzed using Cox regression.

Main Results:

  • 60.3% of analyzed patients had CKD. CKD patients showed higher 1-year bleeding rates (9.2% vs. 4.9%) and all-cause mortality (13.7% vs. 9.1%).
  • Post-TAVR bleeding was significantly associated with increased subsequent mortality (aHR = 2.65, p = .01).
  • No significant difference in stroke rates or antithrombotic strategies was observed between CKD and non-CKD groups.

Conclusions:

  • Chronic kidney disease (CKD) is independently associated with increased bleeding risk up to one year following transcatheter aortic valve replacement (TAVR).
  • Long-term bleeding events after TAVR in CKD patients are linked to a higher risk of subsequent mortality.
  • Current antithrombotic strategies do not appear to differ between CKD and non-CKD patients post-TAVR.
Abstract

Keywords:
TAVRaortic stenosiskidney disease

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