Gloria Färber1, Sabine Bleiziffer2, Torsten Doenst3,4, Dimitra Bon5,6, Andreas Böning7, Helge Weiler8, Eva Herrmann5,6, Christian Frerker9, Andreas Beckmann10, Helge Möllmann11, Stephan Ensminger12, Raffi Bekeredjian13, Thomas Walther14, Wolfgang Harringer15, Hugo A Katus16, Christian W Hamm17, Friedhelm Beyersdorf18, Timm Bauer7, Stephan Fichtlscherer8. 1. Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany. 2. Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany. 3. Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany. doenst@med.uni-jena.de. 4. Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany. doenst@med.uni-jena.de. 5. Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Frankfurt am Main, Germany. 6. German Center for Cardiovascular Research, DZHK, Partner Site Rhein-Main, Frankfurt am Main, Germany. 7. Department of Cardiology, University of Giessen, Giessen, Germany. 8. Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt, Germany. 9. Department of Internal Medicine III, University of Cologne, Cologne, Germany. 10. German Society of Thoracic, Cardiac and Vascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG), Berlin, Germany. 11. Department of Cardiology, St.-Johannes-Hospital Dortmund, Dortmund, Germany. 12. Department of Cardiac Surgery, University of Lübeck, Lübeck, Germany. 13. Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany. 14. Department of Cardiothoracic Surgery, University Hospital Frankfurt, Frankfurt, Germany. 15. Clinic for Cardiac, Thoracic and Vascular Surgery, Klinikum Braunschweig gGmbH, Brunswick, Germany. 16. Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany. 17. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 18. Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, Freiburg, Germany.
Abstract
OBJECTIVES: The aim of this study was to compare outcomes of transcatheter and surgical aortic valve implantation in chronic dialysis patients with aortic valve stenosis (AS). BACKGROUND: Chronic dialysis patients undergoing heart valve surgery are at higher risk for morbidity and mortality. Whether interventional techniques can reduce this risk is unclear because dialysis patients have thus far been excluded from randomized trials. METHODS: Chronic dialysis patients with AS enrolled in the German Aortic Valve Registry (GARY) between 2012 and 2015 were analyzed to compare transcatheter aortic valve implantation (TAVI n = 661) with surgical aortic valve replacement (SAVR n = 457). Propensity scores for inverse probability of treatment weighting (IPTW) were used to adjust the comparison of the two treatment groups for potential confounders. RESULTS: TAVI patients were older (78 ± 7.3 vs. 69 ± 10.2 years, p < 0.01, unadjusted) and had more comorbidities. Mortality at 1 year was the same (TAVI: 33.4% vs. SAVR 35.0%, p = 0.72, IPTW-adjusted) while it was lower with TAVI at 30 days (8.6% vs. 15.0%, p = 0.02, IPTW-adjusted). TAVI patients required more pacemaker implantation and showed more aortic regurgitation. SAVR patients required more blood transfusions and had longer hospital stay. Diabetes mellitus, atrial fibrillation, previous PCI, urgent procedure and EuroSCORE were associated with elevated 30-day mortality. Atrial fibrillation and older age were independent risk factor of 1-year mortality in both groups. CONCLUSIONS: Chronic dialysis patients with AS undergoing TAVI or SAVR had the same 1-year mortality, although survival at 30 days was better with TAVI. These results suggest that TAVI may improve peri-procedural outcomes.
OBJECTIVES: The aim of this study was to compare outcomes of transcatheter and surgical aortic valve implantation in chronic dialysis patients with aortic valve stenosis (AS). BACKGROUND: Chronic dialysis patients undergoing heart valve surgery are at higher risk for morbidity and mortality. Whether interventional techniques can reduce this risk is unclear because dialysis patients have thus far been excluded from randomized trials. METHODS: Chronic dialysis patients with AS enrolled in the German Aortic Valve Registry (GARY) between 2012 and 2015 were analyzed to compare transcatheter aortic valve implantation (TAVI n = 661) with surgical aortic valve replacement (SAVR n = 457). Propensity scores for inverse probability of treatment weighting (IPTW) were used to adjust the comparison of the two treatment groups for potential confounders. RESULTS: TAVI patients were older (78 ± 7.3 vs. 69 ± 10.2 years, p < 0.01, unadjusted) and had more comorbidities. Mortality at 1 year was the same (TAVI: 33.4% vs. SAVR 35.0%, p = 0.72, IPTW-adjusted) while it was lower with TAVI at 30 days (8.6% vs. 15.0%, p = 0.02, IPTW-adjusted). TAVI patients required more pacemaker implantation and showed more aortic regurgitation. SAVR patients required more blood transfusions and had longer hospital stay. Diabetes mellitus, atrial fibrillation, previous PCI, urgent procedure and EuroSCORE were associated with elevated 30-day mortality. Atrial fibrillation and older age were independent risk factor of 1-year mortality in both groups. CONCLUSIONS: Chronic dialysis patients with AS undergoing TAVI or SAVR had the same 1-year mortality, although survival at 30 days was better with TAVI. These results suggest that TAVI may improve peri-procedural outcomes.
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