Long‐Term Outcomes of Transcatheter Aortic Valve Replacement in Patients With End‐Stage Renal Disease

Abstract

Background Aortic stenosis is prevalent in end‐stage renal disease. Transcatheter aortic valve replacement (TAVR) is a plausible alternative for surgical aortic valve replacement. However, little is known regarding long‐term outcomes in patients with end‐stage renal disease who undergo TAVR. Methods and Results We identified all patients with end‐stage renal disease who underwent TAVR from 2011 through 2016 using the United States Renal Data System. The primary end point was 5‐year mortality after TAVR. Factors associated with 1‐ and 5‐year mortality were analyzed. A total of 3883 TAVRs were performed for patients with end‐stage renal disease. Mortality was 5.8%, 43.7%, and 88.8% at 30 days, 1 year, and 5 years, respectively. Case volumes increased rapidly from 17 in 2011 to 1495 in 2016. Thirty‐day mortality demonstrated a dramatic reduction from 11.1% in 2012 to 2.5% in 2016 ( P =0.01). Age 75 or older (hazard ratio [HR], 1.14; 95% CI, 1.05–1.23 [ P =0.002]), body mass index <25 (HR, 1.18; 95% CI, 1.08–1.28 [ P <0.001]), chronic obstructive pulmonary disease (HR, 1.25; 95% CI, 1.1–1.35 [ P <0.001]), diabetes mellitus as the cause of dialysis (HR, 1.22; 95% CI, 1.11–1.35 [ P <0.001]), hypertension as the cause of dialysis (HR, 1.17; 95% CI, 1.06–1.29 [ P =0.004]), and White race (HR, 1.17; 95% CI, 1.06–1.3 [ P =0.002]) were independently associated with 5‐year mortality. Conclusions Short‐term outcomes of TAVR in patients with end‐stage renal disease have improved significantly. However, long‐term mortality of patients on dialysis remains high.