Impact of Varying Degrees of Renal Dysfunction on Transcatheter and Surgical Aortic Valve Replacement
BACKGROUND:
Renal impairment portends adverse outcomes in
patients undergoing valvular heart surgery. The relationship between
renal dysfunction in patients undergoing transcatheter aortic valve
replacement (TAVR) is incompletely understood.
METHODS:
A
retrospective review of 1336 patients undergoing surgical aortic valve
replacement (SAVR; 2002-2012) and 321 patients undergoing TAVR
(2007-2012) was performed. Patients were divided into 3 glomerular
filtration rate (GFR) groups: GFR greater than 60 mL/min, GFR 31 to 60
mL/min, and GFR 30 mL/min or less. Logistic and linear regression
analysis was performed to estimate the TAVR effect on outcomes. Risk
adjustments were made using the Society for Thoracic Surgeons (STS)
predicted risk of mortality (PROM).
RESULTS:
TAVR
patients were older (82 vs 65 years; P < .001), had a poorer ejection
fraction (48% vs 53%; P < .001), were more likely female (45% vs
41%; P = .23), and had a higher STS PROM (11.9% vs 4.6%; P < .001).
In-hospital mortality rates for TAVR and SAVR were 3.5% and 4.1%,
respectively (P = .60), a result that marginally favors TAVR after risk
adjustment (adjusted odds ratio = .52, P = .06). In SAVR patients,
worsening preoperative renal failure was associated with increased
in-hospital mortality (P = .004) and hospital (P < .001) and
intensive care unit (ICU) (P < .001) lengths of stay. In contrast,
worsening renal function did not influence in-hospital mortality
(P = .78) and hospital (P < .23) and ICU (P = .88) lengths of stay in
TAVR patients.
CONCLUSIONS:
Worsening renal function was
associated with increased in-hospital mortality, hospital length of
stay, and ICU length of stay in SAVR patients, but not in TAVR patients.
This unexpected finding may have important clinical implications in
patients with aortic stenosis and preoperative renal dysfunction.
