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TAVR IN CHRONIC RENAL FAILURE PATIENTS ASSOCIATED WITH INCREASED RESOURCE UTILIZATION AND WORSE OUTCOMES
Basel Ramlawi, MD, Walid K. Abu Saleh, MD, Odeaa Al Jabbari, MD, Colin Barker, MD, Chun Lin, MD, Manuel Reyes, MD, Neal Kleiman, MD, Michael J. Reardon, MD.
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
OBJECTIVE: Chronic kidney disease is a significant risk factor for mortality in cardiac surgery. In this study we compared patients undergoing transcatheter aortic valve replacement (TAVR) with end-stage renal disease (ERSD) to non-dialysis patients undergoing TAVR.
METHODS: The Methodist hospital database STS/ACC Transcatheter Valve Therapy (TVT) was retrospectively reviewed from prospectively collected data. We analyzed data of 250 consecutive patients who underwent TAVR from January 2011 through August 2014. Median numerical value was used. Categorical data were expressed as absolute values with percentages and continuous data as mean. Outcome was calculated from the day of the procedure to the date of death or discharge. Data were analyzed using the IBM SPSS Statistics software.
RESULTS: Overall 10/250 patients (4%) of TAVR patients had ESRD requiring dialysis. ESRD patients had a higher median STS predicted risk of mortality (10.7% vs. 6.5%, p<0.001). Compared with non-dialysis patients, dialysis patients had a significantly higher median operative time (141 vs. 111, p=0.002); Length of ventilation (11 vs. 3, p<0.001); Hospital length of stay (19 vs. 8, p<0.001); and Intraoperative transfusions (6% vs. 55%, p=0.007). While non-significant, there was a significantly increased rate of stroke (10% vs. 4%) and postoperative mortality (10% vs. 4%) in ESRD patients. Refer to table for results.
CONCLUSIONS: Among patients undergoing TAVR, those with ESRD on dialysis had a higher operative time, intraoperative transfusion, length of ventilation, and hospital length of stay. Moreover, there was a trend for increased morbidity in the ESRD cohort. This data has implications for patient selection. 
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