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Abstract: FR-PO1130

Transcatheter vs. Surgical Aortic Valve Replacement in US Renal Transplant Patients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Herzog, Charles A., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Wetmore, James B., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States

Group or Team Name

  • Chronic Disease Research Group
Background

Renal Transplant (RT) patients are a high risk group for surgical aortic valve replacement. Few data exist on the comparative outcome of renal transplant patients with aortic stenosis receiving transcatheter (TAVR) vs. surgical (SAVR) aortic valve replacement.

Methods

The CMS 100% ESRD files from 2013-2015 were used to find RT patients receiving TAVR or SAVR, and to compare inpatient death and adjusted 1-year mortality. The cohort comprised patients receiving TAVR or SAVR 1/1/2013-12/31/2014. Patients with endocarditis or multivalve SAVR were excluded. A six-month period prior to the valve replacement procedure was used to assess comorbidity from claims. Post-discharge mortality rates were estimated and Cox proportional hazards models were used to compare post-discharge 1-year mortality, adjusting for patient characteristics and comorbidity.

Results

(Table 1) Of the 303 RT patients receiving aortic valve replacement, 73.3% received SAVR and 26.7% TAVR. TAVR patients were more likely to be older, male, with a higher comorbidity burden. TAVR patients experienced lower inpatient mortality (3.7% vs. 5.4% for SAVR). The post-discharge one year mortality rate was 30.2/100 pt-yrs for TAVR and 12.4/100pt-yrs for SAVR. For those patients discharged alive, the adjusted hazard ratio for one year mortality (TAVR vs SAVR) was 1.1(95% CI, 0.5-2.2).

Conclusion

RT patients undergoing TAVR have lower in-hospital mortality compared to SAVR, but higher post-discharge mortality rate. After adjustment for comorbidity, the hazard ratio for one year mortality is similar for TAVR vs SAVR in RT patients undergoing TAVR and SAVR in 2013-2014. Future studies comparing TAVR to SAVR in the more recent treatment era are warranted.

Table 1. TAVR vs. SAVR, Transplant Patients

Funding

  • Private Foundation Support