End-stage renal disease and severe aortic stenosis: Does valve replacement improve one-year outcomes?

Jose F. Condado; Aneel Maini; Bradley Leshnower; Vinod Thourani; Jessica Forcillo; Chandan Devireddy; Kreton Mavromatis; Eric L. Sarin; James Stewart; Robert Guyton; Amy Simone; Patricia Keegan; Stamatios Lerakis; Peter C. Block; Vasilis Babaliaros

doi:10.1002/ccd.26875

End-stage renal disease and severe aortic stenosis: Does valve replacement improve one-year outcomes?

Jose F. Condado
, Aneel Maini
, Bradley Leshnower
, Vinod Thourani
, Jessica Forcillo
, Chandan Devireddy
, Kreton Mavromatis
, Eric L. Sarin
, James Stewart
, Robert Guyton
, Amy Simone
, Patricia Keegan
, Stamatios Lerakis
, Peter C. Block
, Vasilis Babaliaros

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Background: Treatment for patients with end-stage renal disease (ESRD) and severe aortic stenosis (AS) includes balloon aortic valvuloplasty (BAV), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement. We compared outcomes among these strategies. Methods: A retrospective review of patients with ESRD undergoing treatment for severe AS between 07/2007 and 06/2015 was performed at our center. Patients were classified based on treatment: BAV-only, TAVR, or SAVR. Baseline characteristics and 30-day outcomes were compared among groups. A 1-year survival analysis was performed. Results: Of 85 patients, 25 (29.4%) underwent BAV, 30 (35.3%) TAVR, and 30 (35.3%) SAVR. Patients in the SAVR group, compared to the BAV or TAVR patients, were younger (63 vs. 74 vs. 71 years, P = 0.02) and had less prior stroke (3.3% vs. 12.0% vs. 30.0%, P = 0.008). While all BAV patients had NYHA class III/IV, 93.3% and 76.7% of patients had NYHA class III/IV in the TAVR and SAVR group, respectively (P = 0.001). BAV patients were less likely to have atrial fibrillation than TAVR or SAVR patients (16.0% vs. 43.3% vs. 50.0%, P = 0.03). All patients were high risk, but there was a statistical trend to lower STS scores in the SAVR group (8.6% vs. 13.5% vs. 13.5%, P = 0.08). There was no significant difference in 30-day mortality (16.7% vs. 10.0% vs. 10.0%, P = 0.74), but BAV treated patients had an increased 1-year mortality compared to those treated with TAVR or SAVR (87.0% vs. 32.0%, vs. 36.7%, P=<0.001). Independent predictors of 1-year mortality were a higher STS score (HR 1.026, 95%CI 1.002–1.051) and BAV-only strategy (BAV vs. TAVR: HR 3.961, 95%CI 1.595–9.840), but dialysis duration and type, and SAVR versus TAVR were not. Conclusions: Patients with ESRD and severe AS have a similar and higher survival with TAVR or SAVR when compared to BAV at 1-year. These results may influence patient care decisions favoring valve replacement in AS patients with ESRD.

Original language	English
Pages (from-to)	1109-1115
Number of pages	7
Journal	Catheterization and Cardiovascular Interventions
Volume	89
Issue number	6
DOIs	https://doi.org/10.1002/ccd.26875
State	Published - May 2017
Externally published	Yes

Keywords

aortic stenosis
aortic valve replacement
end-stage renal disease on dialysis

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10.1002/ccd.26875

Cite this

Condado, J. F., Maini, A., Leshnower, B., Thourani, V., Forcillo, J., Devireddy, C., Mavromatis, K., Sarin, E. L., Stewart, J., Guyton, R., Simone, A., Keegan, P., Lerakis, S., Block, P. C., & Babaliaros, V. (2017). End-stage renal disease and severe aortic stenosis: Does valve replacement improve one-year outcomes? Catheterization and Cardiovascular Interventions, 89(6), 1109-1115. https://doi.org/10.1002/ccd.26875

@article{c81aec3fbe0d4118877472315af77936,

title = "End-stage renal disease and severe aortic stenosis: Does valve replacement improve one-year outcomes?",

abstract = "Background: Treatment for patients with end-stage renal disease (ESRD) and severe aortic stenosis (AS) includes balloon aortic valvuloplasty (BAV), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement. We compared outcomes among these strategies. Methods: A retrospective review of patients with ESRD undergoing treatment for severe AS between 07/2007 and 06/2015 was performed at our center. Patients were classified based on treatment: BAV-only, TAVR, or SAVR. Baseline characteristics and 30-day outcomes were compared among groups. A 1-year survival analysis was performed. Results: Of 85 patients, 25 (29.4\%) underwent BAV, 30 (35.3\%) TAVR, and 30 (35.3\%) SAVR. Patients in the SAVR group, compared to the BAV or TAVR patients, were younger (63 vs. 74 vs. 71 years, P = 0.02) and had less prior stroke (3.3\% vs. 12.0\% vs. 30.0\%, P = 0.008). While all BAV patients had NYHA class III/IV, 93.3\% and 76.7\% of patients had NYHA class III/IV in the TAVR and SAVR group, respectively (P = 0.001). BAV patients were less likely to have atrial fibrillation than TAVR or SAVR patients (16.0\% vs. 43.3\% vs. 50.0\%, P = 0.03). All patients were high risk, but there was a statistical trend to lower STS scores in the SAVR group (8.6\% vs. 13.5\% vs. 13.5\%, P = 0.08). There was no significant difference in 30-day mortality (16.7\% vs. 10.0\% vs. 10.0\%, P = 0.74), but BAV treated patients had an increased 1-year mortality compared to those treated with TAVR or SAVR (87.0\% vs. 32.0\%, vs. 36.7\%, P=<0.001). Independent predictors of 1-year mortality were a higher STS score (HR 1.026, 95\%CI 1.002–1.051) and BAV-only strategy (BAV vs. TAVR: HR 3.961, 95\%CI 1.595–9.840), but dialysis duration and type, and SAVR versus TAVR were not. Conclusions: Patients with ESRD and severe AS have a similar and higher survival with TAVR or SAVR when compared to BAV at 1-year. These results may influence patient care decisions favoring valve replacement in AS patients with ESRD.",

keywords = "aortic stenosis, aortic valve replacement, end-stage renal disease on dialysis",

author = "Condado, \{Jose F.\} and Aneel Maini and Bradley Leshnower and Vinod Thourani and Jessica Forcillo and Chandan Devireddy and Kreton Mavromatis and Sarin, \{Eric L.\} and James Stewart and Robert Guyton and Amy Simone and Patricia Keegan and Stamatios Lerakis and Block, \{Peter C.\} and Vasilis Babaliaros",

note = "Publisher Copyright: {\textcopyright} 2016 Wiley Periodicals, Inc.",

year = "2017",

month = may,

doi = "10.1002/ccd.26875",

language = "English",

volume = "89",

pages = "1109--1115",

journal = "Catheterization and Cardiovascular Interventions",

issn = "1522-1946",

publisher = "John Wiley and Sons Inc.",

number = "6",

}

Condado, JF, Maini, A, Leshnower, B, Thourani, V, Forcillo, J, Devireddy, C, Mavromatis, K, Sarin, EL, Stewart, J, Guyton, R, Simone, A, Keegan, P, Lerakis, S, Block, PC & Babaliaros, V 2017, 'End-stage renal disease and severe aortic stenosis: Does valve replacement improve one-year outcomes?', Catheterization and Cardiovascular Interventions, vol. 89, no. 6, pp. 1109-1115. https://doi.org/10.1002/ccd.26875

TY - JOUR

T1 - End-stage renal disease and severe aortic stenosis

T2 - Does valve replacement improve one-year outcomes?

AU - Condado, Jose F.

AU - Maini, Aneel

AU - Leshnower, Bradley

AU - Thourani, Vinod

AU - Forcillo, Jessica

AU - Devireddy, Chandan

AU - Mavromatis, Kreton

AU - Sarin, Eric L.

AU - Stewart, James

AU - Guyton, Robert

AU - Simone, Amy

AU - Keegan, Patricia

AU - Lerakis, Stamatios

AU - Block, Peter C.

AU - Babaliaros, Vasilis

PY - 2017/5

Y1 - 2017/5

N2 - Background: Treatment for patients with end-stage renal disease (ESRD) and severe aortic stenosis (AS) includes balloon aortic valvuloplasty (BAV), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement. We compared outcomes among these strategies. Methods: A retrospective review of patients with ESRD undergoing treatment for severe AS between 07/2007 and 06/2015 was performed at our center. Patients were classified based on treatment: BAV-only, TAVR, or SAVR. Baseline characteristics and 30-day outcomes were compared among groups. A 1-year survival analysis was performed. Results: Of 85 patients, 25 (29.4%) underwent BAV, 30 (35.3%) TAVR, and 30 (35.3%) SAVR. Patients in the SAVR group, compared to the BAV or TAVR patients, were younger (63 vs. 74 vs. 71 years, P = 0.02) and had less prior stroke (3.3% vs. 12.0% vs. 30.0%, P = 0.008). While all BAV patients had NYHA class III/IV, 93.3% and 76.7% of patients had NYHA class III/IV in the TAVR and SAVR group, respectively (P = 0.001). BAV patients were less likely to have atrial fibrillation than TAVR or SAVR patients (16.0% vs. 43.3% vs. 50.0%, P = 0.03). All patients were high risk, but there was a statistical trend to lower STS scores in the SAVR group (8.6% vs. 13.5% vs. 13.5%, P = 0.08). There was no significant difference in 30-day mortality (16.7% vs. 10.0% vs. 10.0%, P = 0.74), but BAV treated patients had an increased 1-year mortality compared to those treated with TAVR or SAVR (87.0% vs. 32.0%, vs. 36.7%, P=<0.001). Independent predictors of 1-year mortality were a higher STS score (HR 1.026, 95%CI 1.002–1.051) and BAV-only strategy (BAV vs. TAVR: HR 3.961, 95%CI 1.595–9.840), but dialysis duration and type, and SAVR versus TAVR were not. Conclusions: Patients with ESRD and severe AS have a similar and higher survival with TAVR or SAVR when compared to BAV at 1-year. These results may influence patient care decisions favoring valve replacement in AS patients with ESRD.

AB - Background: Treatment for patients with end-stage renal disease (ESRD) and severe aortic stenosis (AS) includes balloon aortic valvuloplasty (BAV), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement. We compared outcomes among these strategies. Methods: A retrospective review of patients with ESRD undergoing treatment for severe AS between 07/2007 and 06/2015 was performed at our center. Patients were classified based on treatment: BAV-only, TAVR, or SAVR. Baseline characteristics and 30-day outcomes were compared among groups. A 1-year survival analysis was performed. Results: Of 85 patients, 25 (29.4%) underwent BAV, 30 (35.3%) TAVR, and 30 (35.3%) SAVR. Patients in the SAVR group, compared to the BAV or TAVR patients, were younger (63 vs. 74 vs. 71 years, P = 0.02) and had less prior stroke (3.3% vs. 12.0% vs. 30.0%, P = 0.008). While all BAV patients had NYHA class III/IV, 93.3% and 76.7% of patients had NYHA class III/IV in the TAVR and SAVR group, respectively (P = 0.001). BAV patients were less likely to have atrial fibrillation than TAVR or SAVR patients (16.0% vs. 43.3% vs. 50.0%, P = 0.03). All patients were high risk, but there was a statistical trend to lower STS scores in the SAVR group (8.6% vs. 13.5% vs. 13.5%, P = 0.08). There was no significant difference in 30-day mortality (16.7% vs. 10.0% vs. 10.0%, P = 0.74), but BAV treated patients had an increased 1-year mortality compared to those treated with TAVR or SAVR (87.0% vs. 32.0%, vs. 36.7%, P=<0.001). Independent predictors of 1-year mortality were a higher STS score (HR 1.026, 95%CI 1.002–1.051) and BAV-only strategy (BAV vs. TAVR: HR 3.961, 95%CI 1.595–9.840), but dialysis duration and type, and SAVR versus TAVR were not. Conclusions: Patients with ESRD and severe AS have a similar and higher survival with TAVR or SAVR when compared to BAV at 1-year. These results may influence patient care decisions favoring valve replacement in AS patients with ESRD.

KW - aortic stenosis

KW - aortic valve replacement

KW - end-stage renal disease on dialysis

UR - https://www.scopus.com/pages/publications/85013436863

U2 - 10.1002/ccd.26875

DO - 10.1002/ccd.26875

M3 - Article

C2 - 28211605

AN - SCOPUS:85013436863

SN - 1522-1946

VL - 89

SP - 1109

EP - 1115

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

IS - 6

ER -

End-stage renal disease and severe aortic stenosis: Does valve replacement improve one-year outcomes?

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Keywords

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