OBJECTIVES: The authors sought to elucidate the true incidence of renal replacement therapy (RRT) after transcatheter aortic valve replacement (TAVR). BACKGROUND: There is a wide discrepancy in the reported rate of RRT after TAVR (1.4% to 40%). The true incidence of RRT after TAVR is unknown. METHODS: The STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) registry was linked to the Centers for Medicare & Medicaid database to identify all patients that underwent TAVR from November 2011 through September 2015 and their outcomes. The authors compared rates of death, new RRT, and a composite of both as a function of pre-procedure glomerular filtration rate (GFR), both in stages of chronic kidney disease (CKD), as well as on a continuous scale. RESULTS: Pre-procedure GFR is associated with the risk of death and new RRT after TAVR when GFR is <60 ml/min/m2, and increases significantly when GFR falls below 30 ml/min/m2. Incremental increases in GFR of 5 ml/min/m2 were statistically significant (unadjusted hazard ratio: 0.71; p < 0.001) at 30 days, and continued to be significant at 1 year when pre-procedure GFR was <60 ml/min/m2. One in 3 CKD stage 4 patients will be dead within 1 year, with 14.6% (roughly 1 in 6) requiring dialysis. In CKD stage 5, more than one-third of patients will require RRT within 30 days; nearly two-thirds will require RRT at 1 year. CONCLUSIONS: In both unadjusted and adjusted analysis, pre-procedural GFR was associated with the outcomes of death and new RRT. Increasing CKD stage leads to an increased risk of death and/or RRT. Continuous analysis showed significant differences in outcomes in all levels of CKD when GFR was <60 ml/min/m2. Pre-procedure GFR should be considered when selecting CKD patients for TAVR.
OBJECTIVES: The authors sought to elucidate the true incidence of renal replacement therapy (RRT) after transcatheter aortic valve replacement (TAVR). BACKGROUND: There is a wide discrepancy in the reported rate of RRT after TAVR (1.4% to 40%). The true incidence of RRT after TAVR is unknown. METHODS: The STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) registry was linked to the Centers for Medicare & Medicaid database to identify all patients that underwent TAVR from November 2011 through September 2015 and their outcomes. The authors compared rates of death, new RRT, and a composite of both as a function of pre-procedure glomerular filtration rate (GFR), both in stages of chronic kidney disease (CKD), as well as on a continuous scale. RESULTS: Pre-procedure GFR is associated with the risk of death and new RRT after TAVR when GFR is <60 ml/min/m2, and increases significantly when GFR falls below 30 ml/min/m2. Incremental increases in GFR of 5 ml/min/m2 were statistically significant (unadjusted hazard ratio: 0.71; p < 0.001) at 30 days, and continued to be significant at 1 year when pre-procedure GFR was <60 ml/min/m2. One in 3 CKD stage 4 patients will be dead within 1 year, with 14.6% (roughly 1 in 6) requiring dialysis. In CKD stage 5, more than one-third of patients will require RRT within 30 days; nearly two-thirds will require RRT at 1 year. CONCLUSIONS: In both unadjusted and adjusted analysis, pre-procedural GFR was associated with the outcomes of death and new RRT. Increasing CKD stage leads to an increased risk of death and/or RRT. Continuous analysis showed significant differences in outcomes in all levels of CKD when GFR was <60 ml/min/m2. Pre-procedure GFR should be considered when selecting CKD patients for TAVR.
Authors: Stephan Fichtlscherer; Thomas Walther; Silvia Mas-Peiro; Gloria Faerber; Dimitra Bon; Eva Herrmann; Timm Bauer; Sabine Bleiziffer; Raffi Bekeredjian; Andreas Böning; Christian Frerker; Andreas Beckmann; Helge Möllmann; Stephan Ensminger; Christian W Hamm; Friedhelm Beyersdorf Journal: Clin Res Cardiol Date: 2022-09-08 Impact factor: 6.138
Authors: Binita Shah; Pedro A Villablanca; Sreekanth Vemulapalli; Pratik Manandhar; Nicholas S Amoroso; Muhamed Saric; Cezar Staniloae; Mathew R Williams Journal: Circ Cardiovasc Interv Date: 2019-02 Impact factor: 6.546
Authors: Haijiang Dai; Arwa Younis; Jude Dzevela Kong; Luca Puce; Georges Jabbour; Hong Yuan; Nicola Luigi Bragazzi Journal: Front Cardiovasc Med Date: 2022-04-01
Authors: Rita Calça; Rui C Teles; Patrícia Branco; Augusta Gaspar; João Brito; Tiago Nolasco; Manuel D Almeida; José P Neves; Miguel Mendes; Domingos S Machado; André Weigert Journal: Arq Bras Cardiol Date: 2019-12 Impact factor: 2.000
Authors: Lisa Q Rong; Irbaz Hameed; Arash Salemi; Mohamed Rahouma; Faiza M Khan; Harindra C Wijeysundera; Dominick J Angiolillo; Linda Shore-Lesserson; Giuseppe Biondi-Zoccai; Leonard N Girardi; Stephen E Fremes; Mario Gaudino Journal: J Am Heart Assoc Date: 2019-09-24 Impact factor: 5.501