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Trends of utilization and outcomes after transcatheter and surgical aortic valve replacement on chronic dialysis

Tomo Ando1, Alexandros Briasoulis2, Hisato Takagi3

  • 1Division of Cardiology, Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.

Journal of Cardiac Surgery
|September 28, 2020
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) utilization increased significantly in patients on chronic dialysis (CD), surpassing surgical aortic valve replacement (SAVR). However, outcomes require improvement for this high-risk group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Nephrology

Background:

  • Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are crucial for aortic valve stenosis.
  • Patients on chronic dialysis (CD) represent a high-risk population for these procedures.
  • Limited data exists on the utilization and outcomes of TAVR versus SAVR in CD patients.

Purpose of the Study:

  • To evaluate the trends in utilization of TAVR and SAVR.
  • To compare the in-hospital outcomes of TAVR and SAVR in patients with CD.
  • To identify potential areas for improving aortic valve replacement outcomes in CD patients.

Main Methods:

  • Analysis of the Nationwide Readmission Databases from 2013 to 2017.
  • Identification of TAVR and SAVR procedures using ICD-CM codes.
  • Multivariable regression analysis to compare outcomes, including adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Main Results:

  • TAVR utilization increased four-fold, while SAVR increased 33% among CD patients.
  • TAVR volume surpassed SAVR in CD patients by 2016-2017.
  • In-hospital mortality remained similar for TAVR but increased for SAVR; however, 2017 data showed higher mortality and readmission for TAVR in CD versus non-CD patients.

Conclusions:

  • TAVR use has significantly increased in patients on chronic dialysis.
  • Despite increased utilization, outcomes for TAVR in CD patients warrant further investigation and improvement.
  • There is a continued need to optimize aortic valve replacement strategies for the CD population.
Abstract

Keywords:
chronic dialysissurgical aortic valve replacementtranscatheter aortic valve replacement

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