Aortic Valve Replacement in Patients With ESRD and Heart Failure With Reduced Ejection Fraction.

Autor: Warner ED; Department of Internal Medicine. Electronic address: eric.warner@jefferson.edu., Riley J; Department of Internal Medicine., Liotta M; Department of Internal Medicine., Pritting C; Division of Cardiothoracic Surgery., Brailovsky Y; Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania., Jimenez D; Department of Internal Medicine., Chatterjee A; Division of Cardiovascular Diseases, University of Arizona, Tuscon, Arizona., Tchantchaleishvili V; Division of Cardiothoracic Surgery., Rajapreyar IN; Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: Indranee.rajapreyar@jefferson.edu.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2023 Oct 15; Vol. 205, pp. 111-119. Date of Electronic Publication: 2023 Aug 19.
DOI: 10.1016/j.amjcard.2023.07.161
Abstrakt: Transcatheter aortic valve replacement (TAVR) has become the standard of care for the treatment of all patients with calcific aortic stenosis. Patients with end-stage renal disease (ESRD) on hemodialysis were excluded from participation in many of the seminal trials proving the safety and efficacy of TAVR. The outcomes of TAVR in the ESRD population from a national registry showed significantly higher in-hospital and 1-year mortality compared with patients not on hemodialysis. Comparisons of outcomes for surgical versus transcatheter interventions in patients with ESRD and heart failure with reduced ejection fraction (HFrEF) are limited. Using the United States Renal Data System, we identified all ESRD patients with aortic stenosis and HFrEF who underwent TAVR, surgical aortic valve replacement (SAVR), or those with HFrEF and aortic stenosis initiated on dialysis after the year 2012 to compare survival. Propensity score matching was performed, and groups were compared using Kaplan-Meier curves. The study population consisted of 7,660 patients, of which 5,064 (66.1%) were male. The median age at initiation of dialysis was 73 years (interquartile range: 65 to 80). There were 1,108 (14.5%) who underwent TAVR and 695 (9.1%) who underwent SAVR. After matching, patients who underwent TAVR had increased survival relative to those who were medically managed. In-hospital outcomes favored TAVR with less mortality and fewer complications when compared with SAVR. TAVR had improved mortality relative to SAVR in the early period, but survival curves crossed at approximately 9 months and SAVR had better mortality in the long-term. TAVR is a safe and effective procedure and is associated with improved mortality when compared with medical management. In conclusion, TAVR and SAVR are both viable options for patients with ESRD and HF with TAVR having better short-term outcomes and SAVR better long-term outcomes.
Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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