title: The outcomes of transcatheter aortic valve replacement in a cohort of patients with end-stage renal disease.
abstract: OBJECTIVE
  To examine whether transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for aortic stenosis in patients with end-stage renal disease (ESRD).
  
  
  BACKGROUND
  Patients with ESRD undergoing surgical aortic valve replacement have an operative mortality approaching 20% and a 10-year survival of approximately 12%. We investigated whether TAVR is a more reasonable option.
  
  
  METHODS
  This is a multicenter, retrospective study of all patients with ESRD who underwent TAVR in 8 institutions between 12/2011 and 02/2013. Demographic characteristics, mortality, major, and minor complications were evaluated. Outcomes were stratified by operative approach.
  
  
  RESULTS
  Forty-three patients with a mean age 76.2 ± 11.0 years and a mean STS predicted risk of mortality of 15.53 ± 8.70% underwent TAVR. Mean duration of dialysis was 45.2 ± 52.3 months (median 29.5 months). Transfemoral (TF) TAVR was performed in 31/43 (72.1%), transapical in 11/43 (25.6%), and transaortic in 1/43 (2.3%). Operative mortality was 14.0% (6/43) with TF mortality 6.5% (2/31) and 33.3% (4/12) in non-TF patients. Six-month mortality was 11/43 (25.6%: 16.1% TF, 50.0% non-TF). Complications included stroke in 2.3% (1/43) and life-threatening or major bleeding in 14.0% (6/43). Discharge to another healthcare facility was 27.0% (10/37). Readmission within 30 days of procedure for any cause was 18.9% (7/37).
  
  
  CONCLUSIONS
  Patients with ESRD who undergo TAVR are at high risk for mortality and complications. TAVR outcomes are comparable to but not substantially better than those with SAVR. Transfemoral TAVR seems to be at least as safe and effective as the current standard SAVR in patients undergoing aortic valve replacement. © 2016 Wiley Periodicals, Inc.
authors.affiliation: The Heart Hospital Baylor Plano, Plano, Texas.
authors.forename: Molly
authors.initials: M
authors.lastname: Szerlip
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: Rebeca J
authors.initials: RJ
authors.lastname: Kim
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: Tokunbo
authors.initials: T
authors.lastname: Adeniyi
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Vinod
authors.initials: V
authors.lastname: Thourani
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bavaria
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Saif
authors.initials: S
authors.lastname: Anwaruddin
authors.affiliation: Cedars-Sinai Medical Center, West Hollywood, California.
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
authors.affiliation: Cedars-Sinai Medical Center, West Hollywood, California.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: Morton Plant Hospital, Clearwater, Florida.
authors.forename: Joshua
authors.initials: J
authors.lastname: Rovin
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Don
authors.initials: D
authors.lastname: Creighton
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: D Craig
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Kim
authors.initials: K
authors.lastname: Baio
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Walsh
authors.affiliation: Morton Plant Hospital, Clearwater, Florida.
authors.forename: Jasmina
authors.initials: J
authors.lastname: Katinic
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Letterer
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Leigh
authors.initials: L
authors.lastname: Trautman
authors.affiliation: Medical City Dallas Hospital, Dallas, Texas.
authors.forename: Morley
authors.initials: M
authors.lastname: Herbert
authors.affiliation: Medical City Dallas Hospital, Dallas, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: Farkas
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: Jill
authors.initials: J
authors.lastname: Rudolph
authors.affiliation: The Heart Hospital Baylor Plano, Plano, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Brown
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holper
authors.affiliation: The Heart Hospital Baylor Plano, Plano, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: ESRD; Outcomes; TAVR