title: Transcatheter aortic valve implantation improves outcome compared to open-heart surgery in kidney transplant recipients requiring aortic valve replacement.
abstract: BACKGROUND
  Cardiovascular disease is the most frequent cause of mortality for kidney transplant recipients. Open heart surgery has particularly high mortality and morbidity. As an alternative to traditional aortic valve replacement (AVR) for patients with high-grade aortic stenosis, transcatheter aortic valve implantation (TAVI) was developed as an innovative therapy for patients considered at high surgical risk.
  
  
  METHODS
  We considered all kidney transplant recipients as high-risk patients, which are candidates for TAVI. In 2010 and 2011, eight kidney transplant recipients with severe aortic stenosis underwent TAVI (6 transfemoral; 2 transapical; group I). The outcome of these patients was compared retrospectively to 18 kidney transplant recipients with aortic stenosis, who underwent conventional AVR (group II).
  
  
  RESULTS
  Both groups had similar baseline characteristics, including estimated perioperative risk (EuroSCORE group I vs. group II: 9.5±5.9 vs. 10.4±10.5; p=0.829). All TAVI procedures were performed successfully with excellent functional results. In the TAVI group (group I), all patients were alive at the 12-month follow-up with one cardiovascular event (stroke). In contrast, the surgical group experienced a 30-day-mortality of 11.1% (n=2) and a 1-year-mortality of 16.7% (n=3).
  
  
  CONCLUSIONS
  Based on our center's experience, TAVI appears to be an effective and safe alternative to conventional surgery for AVR in patients with prior renal transplantation. Renal transplantation is not currently identified as a risk factor in our traditional scoring system, and may need to be considered independently when weighing alternatives for AVR.
authors.affiliation: Department of Cardiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Fox
authors.forename: Stefan
authors.initials: S
authors.lastname: Büttner
authors.forename: Katrin
authors.initials: K
authors.lastname: Hemmann
authors.forename: Aida
authors.initials: A
authors.lastname: Asbe-Vollkopf
authors.forename: Mirko
authors.initials: M
authors.lastname: Doss
authors.forename: Andres
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Zeiher
authors.forename: Ernst
authors.initials: E
authors.lastname: Scheuermann
authors.forename: Helmut
authors.initials: H
authors.lastname: Geiger
authors.forename: Stephan
authors.initials: S
authors.lastname: Fichtlscherer
authors.forename: Ingeborg A
authors.initials: IA
authors.lastname: Hauser
authors.forename: Ralf
authors.initials: R
authors.lastname: Lehmann
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000209:etiology* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome