Impact of preoperative chronic kidney disease on short- and long-term outcomes after transcatheter aortic valve implantation: a Pooled-RotterdAm-Milano-Toulouse In Collaboration Plus (PRAGMATIC-Plus) initiative substudy.

Abstract

BACKGROUND:

Only limited and conflicting data on the impact of preoperative chronic kidney disease (CKD) on outcomes after transcatheter aortic valve implantation (TAVI) are available.

METHODS:

We retrospectively analyzed pooled data from the prospective TAVI databases of 4 centers (942 patients). Valve Academic Research Consortium end point definitions were used. The outcomes were compared among patients with normal estimated glomerular filtration rate (≥90 mL/min), mild (60-89 mL/min), moderate (30-59 mL/min), and severe (<30 mL/min) CKD and those on chronic hemodialysis (HD). The primary end point was 1-year survival.

RESULTS:

A total of 109 patients had a normal estimated glomerular filtration rate (11.6%); 329 (34.9%) had mild, 399 (42.5%) moderate, 72 (7.5%) severe CKD, and 33 (3.5%) were on HD. Baseline and procedural characteristics were similar among all groups except for Logistic EuroSCORE. Major stroke, life-threatening bleeding, all-cause 30-day mortality (HD 15.2%, severe CKD 8.3%, moderate CKD 8.3%, mild CKD 6.7%, normal 1.8%, P = .007) and 1-year survival (HD 54.8%, severe CKD 67.2%, moderate CKD 80.0%, mild CKD 85.2%, normal eGFR 91.4%, HD vs severe CKD P = .23, severe CKD vs moderate CKD P = .002, moderate CKD vs mild CKD P = .04, moderate CKD vs normal eGFR P = .03, by log-rank test) differed significantly across groups. Through multivariable analysis, HD and severe CKD were independently associated with an increased risk of 1-year mortality (hazard ratios 5.07 [95% CI 1.79-14.35, P = .002] and 4.03 [95% CI 1.52-10.69, P = .005], respectively).

CONCLUSIONS:

Patients with CKD who undergo TAVI have a higher-risk profile and worse 30-day and 1-year outcomes. Chronic hemodialysis and severe preprocedural CKD are independently associated with an increased risk of 1-year mortality after TAVI.

• Authors: Nicolas Dumonteil, Robert M A van der Boon, Didier Tchetche, Alaide Chieffo, Nicolas M Van Mieghem, Bertrand Marcheix, Gill L Buchanan, Olivier Vahdat, Patrick W Serruys, Jean Fajadet, Antonio Colombo, Peter P T de Jaegere, Didier Carrié
• Journal: American heart journal (Am Heart J) Vol. 165 Issue 5 Pg. 752-60 (May 2013) ISSN: 1097-6744 [Electronic] United States
• PMID: 23622912 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2013 Mosby, Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aortic Valve (surgery)
• Aortic Valve Stenosis (complications, mortality, surgery)
• Cardiac Catheterization (methods)
• Female
• Follow-Up Studies
• France (epidemiology)
• Glomerular Filtration Rate
• Heart Valve Prosthesis Implantation (methods)
• Humans
• Male
• Netherlands (epidemiology)
• Prospective Studies
• Renal Insufficiency, Chronic (complications, mortality, physiopathology)
• Risk Factors
• Survival Rate (trends)