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In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in end stage renal disease
Author(s) -
Alkhalil Ahmad,
Golbari Shervin,
Song David,
Lamba Harveen,
Fares Anas,
Alaiti Amer,
Deo Salil,
Attizzani Guilherme F.,
Ibrahim Homam,
Ruiz Carlos E.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27433
Subject(s) - medicine , propensity score matching , aortic valve replacement , valve replacement , end stage renal disease , cardiology , stenosis , hemodialysis , surgery , aortic valve stenosis , valvular heart disease , heart failure
Background Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with severe symptomatic aortic stenosis (AS) who are at intermediate and high risk for surgery. Commercial use of TAVR has expanded to patients with end stage renal disease (ESRD). Objectives Compare in‐hospital outcomes of TAVR versus SAVR in ESRD patients requiring hemodialysis (HD). Methods ESRD patients on HD undergoing TAVR ( n = 328) or SAVR ( n = 697) between 2012 and 2014 were identified in the National Inpatient Sample (NIS). Propensity‐score matching method was used to minimize selection bias. Baseline characteristics and in‐hospital outcomes were compared. Results TAVR patients were older (75.3 vs. 61.6 years, P < 0.001) and had more comorbidities, including congestive heart failure (16.2% vs. 7.5%), diabetes mellitus (28.4% vs. 22.5%), chronic lung disease (27.7% vs. 20.4%), and peripheral vascular disease (35.1% vs. 21.2%). Propensity‐score matching yielded 175 pairs of patients matched on 30 baseline covariates. Overall in‐hospital mortality was high (9.9%) and similar between TAVR and SAVR (8% vs. 10.3%, P = 0.58). TAVR was associated with shorter length of stay (LOS) (8 vs. 14 days, P < 0.001), lower hospitalization cost ($276,448 vs. $364,280, P = 0.01), lower in‐hospital complications (60.6% vs. 76%, P = 0.003), and higher rate of home discharge (31.4% vs. 17.7%, P = 0.004) compared with SAVR. Conclusions Regardless of treatment modality, patients with AS on HD have high in‐hospital mortality. TAVR and SAVR have comparable in‐hospital mortality in this population. However, TAVR is associated with shorter LOS, lower hospitalization costs, lower in‐hospital complications, and higher rates of home discharge.