In-hospital outcomes of transcatheter versus surgical aortic valve replacement in end stage renal disease

Ahmad Alkhalil, Shervin Golbari, David Song, Harveen Lamba, Anas Fares, Amer Alaiti, Salil Deo, Guilherme F. Attizzani, Homam Ibrahim, Carlos E. Ruiz

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)757-765
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume92
Issue number4
DOIs
StatePublished - Oct 1 2018
Externally publishedYes

Keywords

  • National Inpatient Sample
  • aortic stenosis
  • end-stage renal disease
  • hemodialysis
  • propensity score
  • surgical aortic valve replacement
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Alkhalil, A., Golbari, S., Song, D., Lamba, H., Fares, A., Alaiti, A., Deo, S., Attizzani, G. F., Ibrahim, H., & Ruiz, C. E. (2018). In-hospital outcomes of transcatheter versus surgical aortic valve replacement in end stage renal disease. Catheterization and Cardiovascular Interventions, 92(4), 757-765. https://doi.org/10.1002/ccd.27433