Abstract: SA-PO829

Trends and Outcomes of Surgical versus Transcatheter Aortic Valve Replacement in Patients on Maintenance Dialysis

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Poojary, Priti, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Saha, Aparna, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Patel, Shanti N., Maimonides Medical Center, New York, New York, United States
  • Debnath, Neha, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Chauhan, Kinsuk, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Nadkarni, Girish N., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Chan, Lili, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background

The prevalence of aortic stenosis in maintenance dialysis patients is high (28-55%). Dialysis patients generally have high operative risk for surgical aortic valve replacement (SAVR). While transcatheter aortic valve replacement (TAVR) in high-risk patients is associated with better survival in clinical trials, dialysis patients are generally excluded from these studies. We sought to assess outcomes and trends of SAVR vs. TAVR in dialysis patients from a nationally representative database

Methods

Utilizing the National Inpatient Sample from 2008 – 2014, hospitalizations in dialysis patients for SAVR and TAVR were identified utilizing ICD-9-CM codes. TAVR patients were propensity matched with SAVR patients on demographics, hospital type, primary payer type, income, and Charlson comorbidity index

Results

The proportion of dialysis patients receiving SAVR procedures increased from 2008–2010 (annual percentage change(APC) of 11), then declined from 2010-2014(APC of -2). The proportion of dialysis patients receiving TAVR has significantly increased over time (APC of 69) (Figure 1). Prior to propensity matching, patients in the TAVR group were older(75 vs. 63 years, P<0.001), more likely to be white(67% vs 40%, P<0.001), and more likely to be female(40% vs. 31%, P<0.001). After matching, SAVR was associated with a longer length of stay (18 vs. 10 days, P<.001) and higher cost (76,450 vs. 67,510, P=0.05).TAVR was associated with lower odds for in-hospital mortality [OR 0.46 (95% CI 0.24-0.91)]

Conclusion

TAVR in dialysis patients is increasing and is associated with lower in-hospital mortality. The decreasing trend in SAVR suggests that these patients are now getting TAVRs instead. Patients who are getting TAVRs have different demographics from those getting SAVR. Further investigation is needed to identify reasons for gender and racial differences and evaluation of long-term outcomes between SAVR and TAVR