Acquired cardiovascular disease
Impact of varying degrees of renal dysfunction on transcatheter and surgical aortic valve replacement

Read at the 93rd Annual Meeting of The American Association for Thoracic Surgery, Minneapolis, Minnesota, May 4-8, 2013.
https://doi.org/10.1016/j.jtcvs.2013.07.065Get rights and content
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Background

Renal impairment portends adverse outcomes in patients undergoing valvular heart surgery. The relationship between renal dysfunction in patients undergoing transcatheter aortic valve replacement (TAVR) is incompletely understood.

Methods

A retrospective review of 1336 patients undergoing surgical aortic valve replacement (SAVR; 2002-2012) and 321 patients undergoing TAVR (2007-2012) was performed. Patients were divided into 3 glomerular filtration rate (GFR) groups: GFR greater than 60 mL/min, GFR 31 to 60 mL/min, and GFR 30 mL/min or less. Logistic and linear regression analysis was performed to estimate the TAVR effect on outcomes. Risk adjustments were made using the Society for Thoracic Surgeons (STS) predicted risk of mortality (PROM).

Results

TAVR patients were older (82 vs 65 years; P < .001), had a poorer ejection fraction (48% vs 53%; P < .001), were more likely female (45% vs 41%; P = .23), and had a higher STS PROM (11.9% vs 4.6%; P < .001). In-hospital mortality rates for TAVR and SAVR were 3.5% and 4.1%, respectively (P = .60), a result that marginally favors TAVR after risk adjustment (adjusted odds ratio = .52, P = .06). In SAVR patients, worsening preoperative renal failure was associated with increased in-hospital mortality (P = .004) and hospital (P < .001) and intensive care unit (ICU) (P < .001) lengths of stay. In contrast, worsening renal function did not influence in-hospital mortality (P = .78) and hospital (P < .23) and ICU (P = .88) lengths of stay in TAVR patients.

Conclusions

Worsening renal function was associated with increased in-hospital mortality, hospital length of stay, and ICU length of stay in SAVR patients, but not in TAVR patients. This unexpected finding may have important clinical implications in patients with aortic stenosis and preoperative renal dysfunction.

CTSNet classification

28
28.1
35
35.2

Abbreviations and Acronyms

AKI
acute kidney injury
EF
ejection fraction
ESRD
end-stage renal disease
GFR
glomerular filtration rate
ICU
intensive care unit
OR
odds ratio
PARTNER
Placement of Aortic Transcatheter Valve
PROM
predicted risk of mortality
RD
renal dysfunction
SAVR
surgical aortic valve replacement
STS
Society for Thoracic Surgeons
TAVR
transcatheter aortic valve replacement

Cited by (0)

This study was supported by internal funds from the Division of Cardiothoracic Surgery Clinical Research Unit.

Disclosures: Authors have nothing to disclose with regard to commercial support.