Transcatheter and Surgical Aortic Valve Replacement in Dialysis Patients: A Propensity-Matched Comparison
| Autor: | Sidney Kobrin, Nimesh D. Desai, Dale Kobrin, Saif Anwaruddin, Howard C. Herrmann, Joseph E. Bavaria, Peter W. Groeneveld, Fenton H. McCarthy, Wilson Y. Szeto |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty medicine.medical_treatment Comorbidity Medicare Risk Assessment Transcatheter Aortic Valve Replacement Valve replacement Aortic valve replacement Renal Dialysis medicine Humans Renal Insufficiency Propensity Score Dialysis Aged Aged 80 and over business.industry Aortic Valve Stenosis medicine.disease United States Surgery Clinical trial Aortic valve stenosis Propensity score matching Female Diagnosis code Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of thoracic surgery. 100(4) |
| ISSN: | 1552-6259 |
| Popis: | Transcatheter aortic valve replacement (TAVR) clinical trials in North America excluded patients on dialysis and, consequently, the outcomes of TAVR in dialysis-dependent patients remain unknown.All Medicare fee-for-service patients undergoing TAVR (n = 5,005) or surgical aortic valve replacement (SAVR) (n = 32,634) between January 1, 2011, and November 30, 2012, were identified using procedural codes collected by the Centers for MedicareMedicaid Services. Dialysis status and comorbidities were identified using diagnosis codes present on arrival for TAVR hospitalization. Patients supported on dialysis who underwent TAVR (n = 224) were compared with non-dialysis patients who underwent TAVR as well as a propensity-matched group of contemporaneous dialysis patients who underwent SAVR (n = 194 pairs).The TAVR patients on dialysis were younger than non-dialysis TAVR patients (79.2 years vs 84.1 years; p0.01) but had higher prevalence of comorbidities. Dialysis TAVR patients had increased mortality at 30 days (13% vs 6%, p0.01) and significantly worse survival by Kaplan-Meier analysis. Multivariable regression found dialysis to be independently associated with worse survival (hazard ratio, 1.73; 95% confidence interval, 1.33% to 2.25%, p0.01) in TAVR patients. Propensity-matched dialysis SAVR and dialysis TAVR patients had no significant differences in demographic or risk factors. Matched dialysis TAVR patients had shorter length of stay (6 interquartile range, 4 to 10] vs 10 [IQR 7 to 18] days; p0.01) and comparable survival.TAVR in dialysis patients is associated with decreased survival compared with non-dialysis patients; however, it is comparable with SAVR in high risk dialysis patients based on a propensity-matched comparison. |
| Databáze: | OpenAIRE |
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