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Transcatheter or surgical aortic valve implantation in chronic dialysis patients: a German Aortic Valve Registry analysis

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Abstract

Objectives

The aim of this study was to compare outcomes of transcatheter and surgical aortic valve implantation in chronic dialysis patients with aortic valve stenosis (AS).

Background

Chronic dialysis patients undergoing heart valve surgery are at higher risk for morbidity and mortality. Whether interventional techniques can reduce this risk is unclear because dialysis patients have thus far been excluded from randomized trials.

Methods

Chronic dialysis patients with AS enrolled in the German Aortic Valve Registry (GARY) between 2012 and 2015 were analyzed to compare transcatheter aortic valve implantation (TAVI n = 661) with surgical aortic valve replacement (SAVR n = 457). Propensity scores for inverse probability of treatment weighting (IPTW) were used to adjust the comparison of the two treatment groups for potential confounders.

Results

TAVI patients were older (78 ± 7.3 vs. 69 ± 10.2 years, p < 0.01, unadjusted) and had more comorbidities. Mortality at 1 year was the same (TAVI: 33.4% vs. SAVR 35.0%, p = 0.72, IPTW-adjusted) while it was lower with TAVI at 30 days (8.6% vs. 15.0%, p = 0.02, IPTW-adjusted). TAVI patients required more pacemaker implantation and showed more aortic regurgitation. SAVR patients required more blood transfusions and had longer hospital stay. Diabetes mellitus, atrial fibrillation, previous PCI, urgent procedure and EuroSCORE were associated with elevated 30-day mortality. Atrial fibrillation and older age were independent risk factor of 1-year mortality in both groups.

Conclusions

Chronic dialysis patients with AS undergoing TAVI or SAVR had the same 1-year mortality, although survival at 30 days was better with TAVI. These results suggest that TAVI may improve peri-procedural outcomes.

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Acknowledgements

We wish to thank Elizabeth Martinson of the KHFI Editorial Office and Benjamin May for editorial assistance.

Author information

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany

    Gloria Färber & Torsten Doenst

  2. Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany

    Sabine Bleiziffer

  3. Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Frankfurt am Main, Germany

    Dimitra Bon & Eva Herrmann

  4. German Center for Cardiovascular Research, DZHK, Partner Site Rhein-Main, Frankfurt am Main, Germany

    Dimitra Bon & Eva Herrmann

  5. Department of Cardiology, University of Giessen, Giessen, Germany

    Andreas Böning & Timm Bauer

  6. Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt, Germany

    Helge Weiler & Stephan Fichtlscherer

  7. Department of Internal Medicine III, University of Cologne, Cologne, Germany

    Christian Frerker

  8. German Society of Thoracic, Cardiac and Vascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG), Berlin, Germany

    Andreas Beckmann

  9. Department of Cardiology, St.-Johannes-Hospital Dortmund, Dortmund, Germany

    Helge Möllmann

  10. Department of Cardiac Surgery, University of Lübeck, Lübeck, Germany

    Stephan Ensminger

  11. Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany

    Raffi Bekeredjian

  12. Department of Cardiothoracic Surgery, University Hospital Frankfurt, Frankfurt, Germany

    Thomas Walther

  13. Clinic for Cardiac, Thoracic and Vascular Surgery, Klinikum Braunschweig gGmbH, Brunswick, Germany

    Wolfgang Harringer

  14. Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany

    Hugo A. Katus

  15. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    Christian W. Hamm

  16. Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, Freiburg, Germany

    Friedhelm Beyersdorf

  17. Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany

    Torsten Doenst

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  1. Gloria Färber
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Färber, G., Bleiziffer, S., Doenst, T. et al. Transcatheter or surgical aortic valve implantation in chronic dialysis patients: a German Aortic Valve Registry analysis. Clin Res Cardiol 110, 357–367 (2021). https://doi.org/10.1007/s00392-020-01717-7

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