Short-Term Outcomes of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Kidney Transplant Recipients (from the US Nationwide Representative Study)

Am J Cardiol. 2021 Apr 1:144:83-90. doi: 10.1016/j.amjcard.2020.12.048. Epub 2020 Dec 29.

Abstract

Kidney transplant recipients (KTRs) are considered high-risk patients for surgical interventions. Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative to surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) at high operative risk. However, the outcomes of TAVI compared with SAVR KTRs have not been well-studied in nationally representative data. Patients with prior history of functioning kidney transplant who were hospitalized for TAVI and SAVR between January 2012 and December 2017 were identified retrospectively in the Nationwide Readmissions Database. Our study included 762 TAVI and 1,278 SAVR KTRs. Compared with SAVR, TAVI patients generally had higher rates of co-morbidities with lower risk of in-hospital mortality (3.1% vs 6.3, p = 0.002), blood transfusion (11.5% vs 38.6%, p <0.001), acute myocardial infarction (3.9% vs 6.5%, p = 0.16), acute kidney injury (24.5% vs 42.1%, p <0.001), sepsis (3.9% vs 9.5%, p <0.001) and discharge with disability (42.6% vs 68.4%, p <0.001). However, the rate of permanent pacemaker implantation was significantly higher in TAVI group (11.4% vs 3.9%, p <0.001). Of note, in-hospital stroke and 30-day readmission were comparable between both groups. These findings were confirmed after adjusting for other co-morbidities. TAVI is growing as a valid and safe alternative for KTRs with severe AS.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / epidemiology
  • Aged
  • Aortic Valve Stenosis / surgery*
  • Blood Transfusion / statistics & numerical data
  • Comorbidity
  • Endocarditis / epidemiology
  • Female
  • Heart Valve Prosthesis Implantation / methods
  • Hospital Mortality*
  • Humans
  • Intermediate Care Facilities / statistics & numerical data
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / therapy
  • Kidney Transplantation*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Pacemaker, Artificial / statistics & numerical data
  • Patient Discharge
  • Postoperative Complications / epidemiology*
  • Renal Dialysis
  • Renal Insufficiency, Chronic / epidemiology
  • Retrospective Studies
  • Sepsis / epidemiology
  • Skilled Nursing Facilities / statistics & numerical data
  • Stroke / epidemiology
  • Transcatheter Aortic Valve Replacement / methods*
  • Treatment Outcome
  • United States / epidemiology