(TAVR) has emerged as a viable treatment
option for high-risk patients with severe aortic stenosis (AS) who are not
suitable candidates for surgical aortic valve replacement (SAVR). Although the
published outcomes of the procedure are promising, the risk of developing acute
kidney injury lowers the survival rate of patients post-TAVR.
Kidney disease and valve
health is often a representative of a patient's overall health. Chronic kidney disease (CKD)
is a risk factor for
heart diseases but the development of CKD is often secondary to many other diseases
that are related to heart disease, such as high blood
and poorly controlled diabetes
. Many of
these patients have aortic stenosis, which requires a valve replacement.
Transcatheter aortic valve
a minimally invasive procedure wherein the aortic valve is replaced without
removing the damaged valve. A catheter is used to deliver the replacement valve
to the site of the old valve. After the replacement, the new valve begins
regulating blood flow. This procedure is generally for patients with poor
health conditions where an open-heart valve replacement may be too risky.
findings will help physicians and patients with chronic kidney disease make
more informed decisions about whether patients are good candidates for TAVR",
said lead researcher James W. Hansen, DO, structural interventional cardiology
fellow at the Lahey Hospital and Medical Center in Burlington, Massachusetts.
‘The rate of kidney disease patients who eventually need to start dialysis after undergoing a transcatheter aortic valve replacement (TAVR) is relatively low.
was collected from the Society of Thoracic Surgeons / American College of
Cardiology TVT Registry and included 44,778 non-dialysis patients who underwent
TAVR from 2011 to 2015.
were divided according to their stage of kidney disease. The least severe stage
(stage 1 and 2) of kidney disease was considered the control group. The stages
of kidney disease were measured by how much blood can be filtered by the kidney
in a given period of time.
- Stage 5 chronic kidney disease patients: More than one-third of patients required dialysis within 30
days post-surgery and almost two-thirds required it at one year.
- Stage 4 chronic kidney disease patients: One-third of the patients died within one year of TAVR, with
about one-sixth required dialysis.
- Stage 3 chronic kidney disease patients: 2.2 percent had newly started dialysis 30 days post-surgery
and 3.5 percent had started dialysis one year post-surgery.
- Stages 1 and 2 chronic kidney disease patients: 0.7 percent had newly started dialysis 30 days post-surgery
and 1.2 percent started dialysis one year post-surgery.
"While patients with more severe
chronic kidney disease do have a higher rate of both death and dialysis at 30
days and one year, we're encouraged that the absolute rate of new dialysis is
relatively low in stage 3 patients," Hansen said. "Until now, there has
been no comprehensive data on the risk of dialysis for chronic kidney patients
undergoing TAVR", he said.
study overall suggests that only patients with advanced chronic kidney disease
(stage 4 and stage 5) suffer from high rates of dialysis and death post-TAVR.
- James W. Hansen, Andrew Foy, Pradeep Yadav, Ian C. Gilchrist, Mark Kozak, Amanda Stebbins, Roland Matsouaka, Sreekanth Vemulapalli,Alice Wang, Dee Dee Wang, Marvin H. Eng, Adam B. Greenbaum, William O. O'Neill. Death and Dialysis After Transcatheter Aortic Valve Replacement : An Analysis of the STS/ACC TVT Registry. JACC: Cardiovascular Interventions (2017) https://doi.org/10.1016/j.jcin.2017.09.001