Sustained Success of Transcatheter Aortic Valve Replacement in Patients with Advanced Kidney Disease
Sustained Success of Transcatheter Aortic Valve Replacement in Patients with Advanced Kidney Disease
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Objectives This study sought to determine the association of chronic kidney disease (CKD) and rates of in-valve re-stenosis in patients undergoing transcatheter aortic valve replacement (TAVR).
CKD is a known independent risk factor for worse outcomes after (TAVR). Patients with stage 4-5 CKD have been shown to have both higher in-hospital and one-year mortality versus patients with normal renal function. It was believed that CKD and increased rates of calcification may play a substantial part in the development of aortic stenosis. Is the progression of in-valve re-stenosis a significant factor in symptoms and mortality post TAVR?
In a retrospective, observational study from 2015-2017, we reviewed 124 patients who underwent TAVR at our institution. Included were HD patients with a glomerular filtration rate (GFR) <30mL/min pre-TAVR. We assessed patient’s aortic valve gradients, aortic valve area, and peak velocity immediately post TAVR and then at one year follow up. The primary outcome of interest being progression of aortic stenosis post TAVR.
Included were 124 patients, all of which had stage 4 or 5 CKD (GFR <30mL/min) prior to TAVR. 11 of these patients were deceased at one year. Of the remaining 113 patients, 72 of them had one year follow up echocardiograms. Of these 72 patients, the average increase in mean gradient was 1.22mmHg (+/- 5.06mmHg). The average increase in peak velocity was 0.25m/s (+/- 0.58m/s), and the average AVA was unchanged (0 +/- 0.9cm^2).
Patients with stage 4-5 CKD had no significant change in rates of in-valve re-stenosis at one-year post TAVR. Calcium deposition in the valve annulus has been thought to play a key role in the development of post TAVR re-stenosis. Our study yields results that indicate increased mortality in CKD patients may not be related to increased rates of aortic stenosis post TAVR.
Background
CKD is a known independent risk factor for worse outcomes after (TAVR). Patients with stage 4-5 CKD have been shown to have both higher in-hospital and one-year mortality versus patients with normal renal function. It was believed that CKD and increased rates of calcification may play a substantial part in the development of aortic stenosis. Is the progression of in-valve re-stenosis a significant factor in symptoms and mortality post TAVR?
Methods
In a retrospective, observational study from 2015-2017, we reviewed 124 patients who underwent TAVR at our institution. Included were HD patients with a glomerular filtration rate (GFR) <30mL/min pre-TAVR. We assessed patient’s aortic valve gradients, aortic valve area, and peak velocity immediately post TAVR and then at one year follow up. The primary outcome of interest being progression of aortic stenosis post TAVR.
Results
Included were 124 patients, all of which had stage 4 or 5 CKD (GFR <30mL/min) prior to TAVR. 11 of these patients were deceased at one year. Of the remaining 113 patients, 72 of them had one year follow up echocardiograms. Of these 72 patients, the average increase in mean gradient was 1.22mmHg (+/- 5.06mmHg). The average increase in peak velocity was 0.25m/s (+/- 0.58m/s), and the average AVA was unchanged (0 +/- 0.9cm^2).
Conclusions
Patients with stage 4-5 CKD had no significant change in rates of in-valve re-stenosis at one-year post TAVR. Calcium deposition in the valve annulus has been thought to play a key role in the development of post TAVR re-stenosis. Our study yields results that indicate increased mortality in CKD patients may not be related to increased rates of aortic stenosis post TAVR.