Stephan Fichtlscherer1,2, Thomas Walther3,4, Silvia Mas-Peiro5,3, Gloria Faerber6, Dimitra Bon3,7, Eva Herrmann3,7, Timm Bauer8, Sabine Bleiziffer9, Raffi Bekeredjian10, Andreas Böning11, Christian Frerker12, Andreas Beckmann13, Helge Möllmann14, Stephan Ensminger15, Christian W Hamm3,16, Friedhelm Beyersdorf17,18. 1. Department of Cardiology, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. stephan.fichtlscherer@kgu.de. 2. German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Rhine-Main, Germany. stephan.fichtlscherer@kgu.de. 3. German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Rhine-Main, Germany. 4. Department of Cardiothoracic Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany. 5. Department of Cardiology, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. 6. Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany. 7. Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt am Main, Frankfurt am Main, Germany. 8. Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany. 9. Department of Cardiothoracic Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany. 10. Department of Cardiology, Robert-Bosch Hospital, Stuttgart, Germany. 11. Department of Cardiothoracic Surgery, University Hospital Giessen, Giessen, Germany. 12. Department of Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. 13. German Society of Thoracic and Cardiovascular Surgery, Langenbeck-Virchow-Haus, Berlin, Germany. 14. Department of Cardiology, St. Johannes Hospital, Dortmund, Germany. 15. Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany. 16. Department of Cardiology, Kerckhoff Campus, University of Giessen, Giessen, Germany. 17. Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, University Hospital Freiburg, Freiburg, Germany. 18. Medical Faculty of the Albert-Ludwigs-University Freiburg, Freiburg, Germany.
Abstract
OBJECTIVE: We compared TAVI vs. SAVR in patients with moderate-to-severe chronic kidney disease (eGFR 15-60 ml/min/1.73 m2) for whom both procedures could possibly be considered (age ≤ 80 years, STS-score 4-8). BACKGROUND: According to both ACC/AHA and ESC/EACTS recent guidelines, aortic stenosis may be treated with either transcatheter (TAVI) or surgical (SAVR) aortic valve replacement in a subgroup of patients. A shared therapeutic decision is made by a heart team based on individual factors, including chronic kidney disease (CKD). METHODS: Data from the large nationwide German Aortic Valve Registry were used. A propensity score method was used to select 704 TAVI and 374 SAVR matched patients. Primary endpoint was 1-year survival. Secondary endpoints were clinical complications, including pacemaker implantation, vascular complications, myocardial infarction, bleeding, and the need for new-onset dialysis. RESULTS: One-year survival was similar (HR [95% CI] for TAVI 1.271 [0.795, 2.031], p = 0.316), with no divergence in Kaplan-Meier curves. In spite of post-procedural short-term survival being numerically higher for TAVI patients and 1-year survival being numerically higher for SAVR patients, such differences did not reach statistical significance (96.4% vs. 94.2%, p = 0.199, and 86.2% vs. 81.2%, p = 0.316, respectively). In weighted analyses, pacemaker implantation, vascular complications, and were significantly more common with TAVI; whereas myocardial infarction, bleeding requiring transfusion, and longer ICU-stay and overall hospitalization were higher with SAVR. Temporary dialysis was more common with SAVR (p < 0.0001); however, a probable need for chronic dialysis was rare and similar in both groups. CONCLUSION: Both TAVI and SAVR led to comparable and excellent results in patients with moderate-to-severe CKD in an intermediate-risk population of patients with symptomatic severe aortic stenosis for whom both therapies could possibly be considered.
OBJECTIVE: We compared TAVI vs. SAVR in patients with moderate-to-severe chronic kidney disease (eGFR 15-60 ml/min/1.73 m2) for whom both procedures could possibly be considered (age ≤ 80 years, STS-score 4-8). BACKGROUND: According to both ACC/AHA and ESC/EACTS recent guidelines, aortic stenosis may be treated with either transcatheter (TAVI) or surgical (SAVR) aortic valve replacement in a subgroup of patients. A shared therapeutic decision is made by a heart team based on individual factors, including chronic kidney disease (CKD). METHODS: Data from the large nationwide German Aortic Valve Registry were used. A propensity score method was used to select 704 TAVI and 374 SAVR matched patients. Primary endpoint was 1-year survival. Secondary endpoints were clinical complications, including pacemaker implantation, vascular complications, myocardial infarction, bleeding, and the need for new-onset dialysis. RESULTS: One-year survival was similar (HR [95% CI] for TAVI 1.271 [0.795, 2.031], p = 0.316), with no divergence in Kaplan-Meier curves. In spite of post-procedural short-term survival being numerically higher for TAVI patients and 1-year survival being numerically higher for SAVR patients, such differences did not reach statistical significance (96.4% vs. 94.2%, p = 0.199, and 86.2% vs. 81.2%, p = 0.316, respectively). In weighted analyses, pacemaker implantation, vascular complications, and were significantly more common with TAVI; whereas myocardial infarction, bleeding requiring transfusion, and longer ICU-stay and overall hospitalization were higher with SAVR. Temporary dialysis was more common with SAVR (p < 0.0001); however, a probable need for chronic dialysis was rare and similar in both groups. CONCLUSION: Both TAVI and SAVR led to comparable and excellent results in patients with moderate-to-severe CKD in an intermediate-risk population of patients with symptomatic severe aortic stenosis for whom both therapies could possibly be considered.
Authors: Jeffrey J Popma; G Michael Deeb; Steven J Yakubov; Mubashir Mumtaz; Hemal Gada; Daniel O'Hair; Tanvir Bajwa; John C Heiser; William Merhi; Neal S Kleiman; Judah Askew; Paul Sorajja; Joshua Rovin; Stanley J Chetcuti; David H Adams; Paul S Teirstein; George L Zorn; John K Forrest; Didier Tchétché; Jon Resar; Antony Walton; Nicolo Piazza; Basel Ramlawi; Newell Robinson; George Petrossian; Thomas G Gleason; Jae K Oh; Michael J Boulware; Hongyan Qiao; Andrew S Mugglin; Michael J Reardon Journal: N Engl J Med Date: 2019-03-16 Impact factor: 91.245
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Authors: Michael J Reardon; Nicolas M Van Mieghem; Jeffrey J Popma; Neal S Kleiman; Lars Søndergaard; Mubashir Mumtaz; David H Adams; G Michael Deeb; Brijeshwar Maini; Hemal Gada; Stanley Chetcuti; Thomas Gleason; John Heiser; Rüdiger Lange; William Merhi; Jae K Oh; Peter S Olsen; Nicolo Piazza; Mathew Williams; Stephan Windecker; Steven J Yakubov; Eberhard Grube; Raj Makkar; Joon S Lee; John Conte; Eric Vang; Hang Nguyen; Yanping Chang; Andrew S Mugglin; Patrick W J C Serruys; Arie P Kappetein Journal: N Engl J Med Date: 2017-03-17 Impact factor: 91.245
Authors: Martin B Leon; Craig R Smith; Michael J Mack; Raj R Makkar; Lars G Svensson; Susheel K Kodali; Vinod H Thourani; E Murat Tuzcu; D Craig Miller; Howard C Herrmann; Darshan Doshi; David J Cohen; Augusto D Pichard; Samir Kapadia; Todd Dewey; Vasilis Babaliaros; Wilson Y Szeto; Mathew R Williams; Dean Kereiakes; Alan Zajarias; Kevin L Greason; Brian K Whisenant; Robert W Hodson; Jeffrey W Moses; Alfredo Trento; David L Brown; William F Fearon; Philippe Pibarot; Rebecca T Hahn; Wael A Jaber; William N Anderson; Maria C Alu; John G Webb Journal: N Engl J Med Date: 2016-04-02 Impact factor: 91.245
Authors: Catherine M Otto; Rick A Nishimura; Robert O Bonow; Blase A Carabello; John P Erwin; Federico Gentile; Hani Jneid; Eric V Krieger; Michael Mack; Christopher McLeod; Patrick T O'Gara; Vera H Rigolin; Thoralf M Sundt; Annemarie Thompson; Christopher Toly Journal: Circulation Date: 2020-12-17 Impact factor: 29.690