Background: Transcatheter aortic valve replacement (TAVR) is an alternative form of treatment for patients with aortic valve disease who are otherwise considered a high risk candidate for surgical aortic valve replacement (SAVR). Chronic kidney disease (CKD) is known to adversely affect the outcomes of cardiac surgery including SAVR. We aimed to determine the outcomes of TAVR in patients with CKD, which has not been widely reported.
Methods: A retrospective observational study was conducted on 241 consecutive TAVR patients (81.6 +/- 8.1 years old, 58% females (140 of 241)) treated between January 2011 and April 2015 at a single academic institution. CKD was defined as glomerular filtration rate (GFR) below 60 mL/min.
Results: Ninety-five out of 241 (39.42%) TAVR recipients had CKD. Patients with CKD had a significantly higher Society of Thoracic Surgeons (STS) score (13.8% +/- 9.5, vs. 9.3% +/- 5.013; p-value <0.001), but there was no difference in age, left ventricular ejection fraction, or aortic valve area prior to TAVR. Patients with CKD had a longer intensive care unit stay (149.4 +/- 188.9 vs. 105.5 +/- 87.1 hours; p = 0.037) and hospital stay (14.4 +/- 11.7 vs. 11.5 +/- 7.5 days; p = 0.036). Postoperative worsening of kidney dysfunction (20% (19 of 95) vs. 6.9% (9 of 131); p = 0.003) and vascular complications (7.4% (7 of 95) vs 1.5% (2 of 131); p = 0.027) were more frequent in CKD patients. There were trends towards increased in-hospital mortality (3.16% (3 of 95) vs. 2.27% (3 of 132); p = 0.68) and 1-year mortality (9.47% (9 of 95) vs. 4.55% (6 of 132); p = 0.14) in CKD patients. When adjusted for significant comorbidities (i.e. diabetes, coronary artery disease, congestive heart failure and pulmonary hypertension), CKD was not associated with increased in-hospital mortality, but the risk of 1-year mortality was significantly increased (adjusted odds ratio 3.2, 95% confidence interval 1.01-9.96; p = 0.048).
Conclusions: A significant proportion of TAVR recipients suffer from chronic kidney disease. These patients were more likely to experience vascular complications and worsening of renal dysfunction, a prolonged intensive care unit and hospital length of stay, and an increased one-year mortality. Additional prospective randomized studies of this important patient population are warranted.