BACKGROUND: Renal impairment portends adverse outcomes in patients undergoing valvular heart surgery. The relationship between renal dysfunction in patients undergoing transcatheter aortic valve replacement (TAVR) is incompletely understood. METHODS: A retrospective review of 1336 patients undergoing surgical aortic valve replacement (SAVR; 2002-2012) and 321 patients undergoing TAVR (2007-2012) was performed. Patients were divided into 3 glomerular filtration rate (GFR) groups: GFR greater than 60 mL/min, GFR 31 to 60 mL/min, and GFR 30 mL/min or less. Logistic and linear regression analysis was performed to estimate the TAVR effect on outcomes. Risk adjustments were made using the Society for Thoracic Surgeons (STS) predicted risk of mortality (PROM). RESULTS: TAVR patients were older (82 vs 65 years; P < .001), had a poorer ejection fraction (48% vs 53%; P < .001), were more likely female (45% vs 41%; P = .23), and had a higher STS PROM (11.9% vs 4.6%; P < .001). In-hospital mortality rates for TAVR and SAVR were 3.5% and 4.1%, respectively (P = .60), a result that marginally favors TAVR after risk adjustment (adjusted odds ratio = .52, P = .06). In SAVR patients, worsening preoperative renal failure was associated with increased in-hospital mortality (P = .004) and hospital (P < .001) and intensive care unit (ICU) (P < .001) lengths of stay. In contrast, worsening renal function did not influence in-hospital mortality (P = .78) and hospital (P < .23) and ICU (P = .88) lengths of stay in TAVR patients. CONCLUSIONS: Worsening renal function was associated with increased in-hospital mortality, hospital length of stay, and ICU length of stay in SAVR patients, but not in TAVR patients. This unexpected finding may have important clinical implications in patients with aortic stenosis and preoperative renal dysfunction.
BACKGROUND:Renal impairment portends adverse outcomes in patients undergoing valvular heart surgery. The relationship between renal dysfunction in patients undergoing transcatheter aortic valve replacement (TAVR) is incompletely understood. METHODS: A retrospective review of 1336 patients undergoing surgical aortic valve replacement (SAVR; 2002-2012) and 321 patients undergoing TAVR (2007-2012) was performed. Patients were divided into 3 glomerular filtration rate (GFR) groups: GFR greater than 60 mL/min, GFR 31 to 60 mL/min, and GFR 30 mL/min or less. Logistic and linear regression analysis was performed to estimate the TAVR effect on outcomes. Risk adjustments were made using the Society for Thoracic Surgeons (STS) predicted risk of mortality (PROM). RESULTS: TAVR patients were older (82 vs 65 years; P < .001), had a poorer ejection fraction (48% vs 53%; P < .001), were more likely female (45% vs 41%; P = .23), and had a higher STS PROM (11.9% vs 4.6%; P < .001). In-hospital mortality rates for TAVR and SAVR were 3.5% and 4.1%, respectively (P = .60), a result that marginally favors TAVR after risk adjustment (adjusted odds ratio = .52, P = .06). In SAVR patients, worsening preoperative renal failure was associated with increased in-hospital mortality (P = .004) and hospital (P < .001) and intensive care unit (ICU) (P < .001) lengths of stay. In contrast, worsening renal function did not influence in-hospital mortality (P = .78) and hospital (P < .23) and ICU (P = .88) lengths of stay in TAVR patients. CONCLUSIONS: Worsening renal function was associated with increased in-hospital mortality, hospital length of stay, and ICU length of stay in SAVR patients, but not in TAVR patients. This unexpected finding may have important clinical implications in patients with aortic stenosis and preoperative renal dysfunction.
Authors: Matthias Renker; Akos Varga-Szemes; U Joseph Schoepf; Stefan Baumann; Davide Piccini; Michael O Zenge; Wolfgang G Rehwald; Edgar Müller; Jeremy D Rier; Helge Möllmann; Christian W Hamm; Daniel H Steinberg; Carlo N De Cecco Journal: Eur Radiol Date: 2015-07-20 Impact factor: 5.315
Authors: Marc Najjar; Halit Yerebakan; Robert A Sorabella; Denis J Donovan; Alexander P Kossar; Sowmyashree Sreekanth; Paul Kurlansky; Michael A Borger; Michael Argenziano; Craig R Smith; Isaac George Journal: J Card Surg Date: 2015-06-24 Impact factor: 1.620
Authors: Michel V Lemes da Silva; Antonio C B Nunes Filho; Vitor E E Rosa; Adriano Caixeta; Pedro A Lemos Neto; Henrique B Ribeiro; Breno O Almeida; José Mariani; Carlos M Campos; Alexandre A C Abizaid; José A Mangione; Roney O Sampaio; Paulo Caramori; Rogério Sarmento-Leite; Flávio Tarasoutchi; Marcelo Franken; Fábio S de Brito Journal: PLoS One Date: 2021-05-13 Impact factor: 3.240
Authors: Takegawa Yoshida; Kim-Lien Nguyen; Puja Shahrouki; William J Quinones-Baldrich; Peter F Lawrence; J Paul Finn Journal: J Vasc Surg Date: 2019-11-14 Impact factor: 4.860