Association between advanced chronic kidney disease and left-sided transcatheter heart valve re-intervention

Evidence regarding whether advanced chronic kidney disease (ACKD) serves as an independent risk factor for shorter time to valve re-intervention remains limited.

This study investigates the prognostic association between ACKD and transcatheter heart valve re-intervention (THVr) in patients with left-sided bioprosthetic valves.

We conducted a retrospective study of patients who underwent THVr between November 2011 and March 2025 following prior surgical or transcatheter bioprosthetic aortic or mitral valve replacement. Patients with estimated glomerular filtration rate (eGFR) ≤45 ml/min/1.73 m² at the time of re-intervention were categorized as having ACKD and were compared to those without ACKD.

Among 271 THVr patients (mean age 74 ± 10 years, 57.2% males, 77.0% Caucasians), 241 underwent aortic and 30 underwent mitral valve re-intervention. ACKD was identified in 27 patients (10%). ACKD patients were younger (68.8 vs. 74.8 years, p = 0.003), more frequently African American (51.9% vs 13.9%, p < 0.01), had higher rates of prior myocardial infarction (31.6% vs 12.2%, p = 0.033), and higher Society of Thoracic Surgeons (STS) score (8.8 vs 5.5, p = 0.032). ACKD patients had a significantly shorter time to THVr (7.4 vs 10.1 years, p = 0.012). Interval decline in eGFR was independently associated with shorter time to THVr. In-hospital outcomes were similar between groups, including mortality (0% vs 0.8%; p = 1), blood transfusion (18.5% vs 10.7%, p = 0.21), any bleeding (7.4% vs 5.7%, p = 0.7), or stroke (3.7% vs 0.8%, p = 0.27).

ACKD patients undergoing THVr tend to be younger and have advanced co-morbidities. The interval decline in their eGFR may be associated with accelerated time to THVr. These observational findings are hypothesis generating, suggesting a need for enhanced surveillance for early detection of valve deterioration.