Chronic kidney disease is associated with increased mortality and procedural complications in transcatheter aortic valve replacement: a systematic review and meta‐analysis

Rattanawong, Pattara; Kanitsoraphan, Chanavuth; Kewcharoen, Jakrin; Riangwiwat, Tanawan; Chongyangyuenvong, Pitchaporn; Vutthikraivit, Wasawat; Mannem, Santhosh; Chung, Eugene H.

doi:10.1002/ccd.28102

Cited by 14 publications

(17 citation statements)

References 36 publications

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“…CKD has been associated with higher mortality and morbidity in women undergoing TAVR [ 35 ], and, in our analysis, it was an independent predictor of life-threatening bleeding. A recent meta-analysis confirmed the higher risk of mortality and procedural complications in patients with severe CKD [ 36 ]. About one-fourth of female patients in our analysis presented a severe impairment of renal function that is frequently related to lower levels of hemoglobin.…”

Section: Discussionmentioning

confidence: 96%

Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project

Denegri

Romano

Petronio

et al. 2021

JCDD

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Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR); however, sex-related differences are still debated. This research aimed to examine gender differences in a real-world transcatheter aortic valve replacement (TAVR) cohort. Methods: All-comer aortic stenosis (AS) patients undergoing TAVR with a Medtronic valve across 19 Italian sites were prospectively included in the Italian Clinical Service Project (NCT01007474) between 2007 and 2019. The primary endpoint was 1-year mortality. We also investigated 3-year mortality, and ischemic and hemorrhagic endpoints, and we performed a propensity score matching to assemble patients with similar baseline characteristics. Results: Out of 3821 patients, 2149 (56.2%) women were enrolled. Compared with men, women were older (83 ± 6 vs. 81 ± 6 years, p < 0.001), more likely to present severe renal impairment (GFR ≤ 30 mL/min, 26.3% vs. 16.3%, p < 0.001) but had less previous cardiovascular events (all p < 0.001), with a higher mean Society of Thoracic Surgeons (STS) score (7.8% ± 7.1% vs. 7.2 ± 7.5, p < 0.001) and a greater mean aortic gradient (52.4 ± 15.3 vs. 47.3 ± 12.8 mmHg, p < 0.001). Transfemoral TAVR was performed more frequently in women (87.2% vs. 82.1%, p < 0.001), with a higher rate of major vascular complications and life-threatening bleeding (3.9% vs. 2.4%, p = 0.012 and 2.5% vs. 1.4%, p = 0.024). One-year mortality differed between female and male (11.5% vs. 15.0%, p = 0.002), and this difference persisted after adjustment for significant confounding variables (Adj.HR1yr 1.47, 95%IC 1.18–1.82, p < 0.001). Three-year mortality was also significantly lower in women compared with men (19.8% vs. 24.9%, p < 0.001) even after adjustment for age, STS score, eGFR, diabetes and severe COPD (Adj.HR3yr 1.42, 95%IC 1.21–1.68, p < 0.001). These results were confirmed in 689 pairs after propensity score matching. Conclusion: Despite higher rates of peri-procedural complications, women presented better survival than men. This better adaptive response to TAVR may be driven by sex-specific factors.

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Section: Discussionmentioning

confidence: 96%

Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project

Denegri

Romano

Petronio

et al. 2021

JCDD

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“…[ 36 ] In addition, CKD is as prevalent in VHD patients as VHD is in CKD patients, with the prevalence of CKD ranging between 25% and 75% in patients with significant VHD. [ 20 , 23 , 37 – 39 ]…”

Section: Mitral and Aortic Valve Diseasementioning

confidence: 99%

“…[ 22 ] This is the case even in dialysis and advanced CKD patients (GFR <30 ml/min/1.73 m 2 ), who have high mortality rates after any kind of cardiac intervention. [ 39 , 50 – 54 ] More specifically, dialysis patients have a 30-day mortality rate of up to 21% following SAVR and a 1-year mortality rate of between 34% and 53% following SAVR. [ 23 , 32 , 52 , 55 ] These high mortality outcomes have led to the use of TAVR.…”

Section: Clinical Presentationmentioning

confidence: 99%

Valvular Heart Disease in Patients with Chronic Kidney Disease

2022

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Valvular heart disease (VHD) is highly prevalent in patients with chronic kidney disease (CKD) from the early stages to end-stage renal disease (ESRD). Aortic and mitral valves are the most frequently affected, leading to aortic valve and/or mitral annular calcification, which, in turn, causes either valve stenosis or regurgitation at an accelerated rate compared with the general population. Tricuspid regurgitation is also prevalent in CKD and ESRD, and haemodialysis patients are at an increasingly high risk of infective endocarditis. As for pathophysiology, several mechanisms causing VHD in CKD have been proposed, highlighting the complexity of the process. Echocardiography constitutes the gold standard for the assessment of VHD in CKD/ESRD patients, despite the progress of other imaging modalities. With regard to treatment, the existing 2017 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on the management of VHD addressing patients with normal kidney function are also applied to patients with CKD/ESRD.

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“…Transcatheter aortic valve replacement (TAVR) has become a viable treatment option for aortic stenosis in patients with many different comorbidities, including those with chronic kidney disease (CKD) 1‐3 . In studies using national and regional databases, the prevalence of CKD in the TAVR population ranges from 33 to 45% 4‐6 . Given this high prevalence, it is prudent to better characterize the long‐term risks in patients with CKD undergoing TAVR.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] In studies using national and regional databases, the prevalence of CKD in the TAVR population ranges from 33 to 45%. [4][5][6] Given this high prevalence, it is prudent to better characterize the long-term risks in patients with CKD undergoing TAVR.…”

Section: Introductionmentioning

confidence: 99%

Impact of bleeding after transcatheter aortic valve replacement in patients with chronic kidney disease

Patel

Flannery

et al. 2020

Cathet Cardio Intervent

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Objective: In patients with chronic kidney disease (CKD) undergoing transcatheter aortic valve replacement (TAVR), this study aims to elucidate (a) the bleeding risks associated with CKD, (b) the association between bleeding and subsequent mortality, and (c) the pattern of antithrombotic therapy prescribed. Background: Patients with CKD have a higher risk of bleeding following TAVR. It is unclear whether this risk persists beyond the periprocedural period and whether it negatively impacts mortality. Methods: A retrospective review was performed on patients who underwent TAVR at Massachusetts General Hospital from 2008 to 2017. CKD was defined as estimated glomerular filtration rate less than 60 ml/min/1.73 m 2. Primary endpoints up to 1-year following TAVR included bleeding, all-cause mortality, and ischemic stroke. Outcomes for patients with and without CKD were compared using log-rank test, and Cox regression with age, sex, and diabetes as covariates. Bleeding was treated as a time-varying covariate, and Cox proportional hazard regression was utilized to model mortality. Results: Of the 773 patients analyzed, 466 (60.3%) had CKD. At 1 year, CKD patients had higher rates of bleeding (9.2 vs. 4.9%, adjusted hazard ratios [aHR] = 1.91, p = .032) and all-cause mortality (13.7 vs. 9.1%, aHR = 1.57, p = .049), but not stroke (3.9 vs. 1.6% aHR = 0.073, p = .094). Bleeding was associated with an increased risk of subsequent mortality (aHR = 2.65, 95% CI: 1.25-5.63, p = .01). There were no differences in the antithrombotic strategy following TAVR between CKD and non-CKD patients. Conclusion: CKD is associated with a higher risk of bleeding up to 1 year following TAVR. Long-term bleeding after TAVR is associated with increased subsequent mortality.

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Chronic kidney disease is associated with increased mortality and procedural complications in transcatheter aortic valve replacement: a systematic review and meta‐analysis

Cited by 14 publications

References 36 publications

Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project

Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project

Valvular Heart Disease in Patients with Chronic Kidney Disease

Impact of bleeding after transcatheter aortic valve replacement in patients with chronic kidney disease

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