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

https://doi.org/10.1016/j.amjcard.2020.12.048Get rights and content

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.

Section snippets

Methods

We performed a retrospective cohort study following the STROBE checklist and using the NRD database released by the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ).3 The NRD is a nationally representative database of hospital admissions in United States (US) non-federal hospitals. It includes up to 17 million discharges each year in up to 27 states, accounting for about 57% of all hospitalizations in the US and providing discharge weights

Results

Our study included 2,040 KTR patients who underwent an AVR procedure, of which 762 underwent TAVI, and 1,278 underwent SAVR. KTRs represented 0.4% and 0.3% of all TAVI and SAVR patients in the NRD, respectively. TAVI patients were more likely to have CHF, hypertension, liver disease, DM, dyslipidemia, obesity, a history of myocardial infarction, and a history of a stroke and/or TIA, but less likely to have atrial fibrillation and atrial flutter (Table 1). Although the number of SAVR procedures

Discussion

Using contemporary nationwide data, our main findings suggest that TAVI in KTRs is a safe alternative to SAVR with favorable short-term outcomes. To our knowledge, there have been few published reports focusing on outcomes of aortic valve replacement (AVR) in KTRs.6, 7, 8, 9 In respect of both SAVR and TAVI, very limited studies addressed outcomes of SAVR and TAVI in the unique KTRs population.6,8,10,11

In the present study, KTRs who underwent TAVI were older and had higher frequencies of

Disclosure

The authors declare no conflict of interest.

Ethical Approval

This study was exempted from the institutional review board's approval because it used anonymized and de-identified data in a publicly available database.

Credit Author Statement

Omar M. Abdelfattah and Anas M. Saad: Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Writing – original draft; Abdelrahman Aboshouk, Mohamed Hassanein, and Toshiaki Isogai: Conceptualization, Methodology, Writing - original draft; Mohamed M. Gad and Keerat Rai Ahuja: Visualization, Software, Writing – review & editing; James Yun and Amar Krishnaswamy: Conceptualization, Supervision, Validation, Writing – review & editing; Samir Kapadia:

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this study.

Acknowledgments

This work was made possible by a generous gift from Jennifer and Robert McNeil. The funders had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and the preparation, review, or approval of the manuscript.

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  • Cited by (5)

    These authors contributed equally to this work and are considered joint first authors

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