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Abstract: FR-PO1042

Transcatheter vs. Surgical Aortic Valve Replacement in US Dialysis Patients

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Wetmore, James B., Hennepin Healthcare, Minneapolis, Minnesota, United States
  • Roetker, Nicholas S., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Goessl, Mario, Minneapolis Heart Institute, Minneapolis, Minnesota, United States
  • Johansen, Kirsten L., Hennepin Healthcare, Minneapolis, Minnesota, United States
  • Herzog, Charles A., Hennepin Healthcare, Minneapolis, Minnesota, United States
Background

The benefits of transcatheter aortic valve replacement (TAVR) vs. surgical (SAVR) valve replacement are uncertain among patients receiving maintenance dialysis with aortic stenosis. We compared inpatient and 1-year mortality in dialysis patients with aortic stenosis receiving TAVR vs. SAVR.

Methods

We used the CMS 100% ESRD files from 2013-2015 to compare characteristics and outcomes among patients receiving TAVR or SAVR. The cohort comprised patients receiving an AVR between January 1, 2013 and December 31, 2014. Outcomes of interest were inpatient and 1-year mortality. We used the six-month period prior to the procedure to assess comorbidity using claims. We used Cox proportional hazards models to compare 1-year mortality, adjusting for patient characteristics and comorbidity.

Results

Of the 1867 patients who received an AVR, 66.1% received SAVR and 33.9% TAVR. TAVR patients were more likely to be older, female, white, and have a higher comorbidity burden. Although TAVR patients experienced less inpatient mortality (4.6% vs. 7.8% for SAVR), there was no difference in 1-year mortality among those discharged alive (HR 1.1, 95% CI 0.9-1.4).

Conclusion

Although TAVR is an increasingly attractive option compared to SAVR in the general population, there is less evidence supporting its use in dialysis patients. Short term outcomes appeared to be better among dialysis patients receiving TAVR despite their older age and greater comorbidity burden, and 1-year mortality was not significantly different than for SAVR.