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Abstract: FR-PO1041

All Types of Aortic Valve Replacement (AVR) May Not Be Equal in ESRD: Survival After Bioprosthetic, Mechanical, and Transcatheter AVR (bAVR, mAVR, and TAVR)

Session Information

Category: Hypertension and CVD

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

Authors

  • Sarabu, Nagaraju, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
  • Ngendahimana, David K., Case Western Reserve University, Cleveland, Ohio, United States
  • Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States
  • Deo, Salil, Case Western Reserve University, Cleveland, Ohio, United States
Background

Guidelines have no preference for bAVR or mAVR or TAVR in patients with ESRD. Their outcomes among those who subsequently get transplants is unclear.

Methods

All adult ESRD patients who were underwent AVR, between 1992 and 2015, were identified from the United States Renal Data System (USRDS) using ICD-9 codes. Baseline comorbidities were also identified using ICD-9 codes. Time to death was compared among the three groups (bAVR, mAVR, and TAVR) using Kaplan-Meier survival curves and with aHR (adjusted HR) using Cox proportional hazards model. These statistical procedures were performed separately for entire ESRD cohort and exclusively for those who subsequently underwent kidney transplant. TAVR group was excluded from latter analysis due to low numbers.

Results

There were a total of 9865 patients who underwent AVR (bAVR=4292, mAVR=4951, TAVR=622). Patients who underwent mAVR were the youngest and had the least comorbidity profile. Patients who underwent TAVR were the oldest and had the highest comorbidity profile (Fig 1). For the entire cohort, compared to bAVR, mAVR had better survival (aHR:0.80.90.96 ) but TAVR had worse survival (aHR: 1.141.271.42). Among those who subsequently got kidney transplant, there was no difference in survival for the mAVR group compared to bAVR (aHR:0.81.091.53) (Fig 2).

Conclusion

Mechanical AVR is the preferred choice in ESRD. TAVR may be associated with worse survival but it may be due to higher baseline comorbidity.