title: Impact of Renal Dysfunction on Results of Transcatheter Aortic Valve Replacement Outcomes in a Large Multicenter Cohort.
abstract: Patients with advanced chronic renal dysfunction were excluded from randomized trials of transcatheter aortic valve replacement (TAVR). The potential impact of chronic renal disease on TAVR prognosis is not fully understood. We aim to evaluate outcomes within a large cohort of patients who underwent TAVR distinguished by renal function. Baseline characteristics, procedural data, and clinical follow-up findings were collected from 10 high-volume TAVR centers in Europe, Israel, and Japan. Data were analyzed according to renal function. Patients (n = 1,204) were divided into 4 groups according to pre-TAVR-estimated glomerular filtration rate (eGFR): group I (eGFR >60), n = 288 (female 45%), group II (eGFR 31 to 60), n = 452 (female 61%), group III (eGFR ≤30), n = 398 (female 61%), and group IV (dialysis), n = 66 (female 31%). Mean Society of Thoracic Surgeons score was higher in patients with lower preprocedural eGFR. All-cause mortality at 1 year was higher in patients with lower eGFR (9.0%, 12.1%, 24.3%, and 24.2% for group I, II, III, and IV, respectively, p <0.001). Multivariate analysis demonstrated that eGFR ≤30, but not eGFR 31 to 60, was associated with increased risk of death (odds ratio 3), bleeding (odds ratio 5.2), and device implantation failure (hazard ratio 2.28). For each 10 ml/min decrease in eGFR, there was an associated relative increase in the risk of death (35%; p <0.001), cardiovascular death (14%; p = 0.018), major bleeding 35% (p <0.001), and transcatheter valve failure (16%; p = 0.007). Renal dysfunction was not associated with stroke or need for pacemaker implantation. In conclusion, among patients who underwent TAVR, baseline renal dysfunction is an important independent predictor of morbidity and mortality.
authors.affiliation: Cardiology Department, Rabin Medical Center, Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Pablo
authors.initials: P
authors.lastname: Codner
authors.affiliation: Cardiology Department, Rabin Medical Center, Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Amos
authors.initials: A
authors.lastname: Levi
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy; Cardiology Department, Inselspital University Hospital, Bern, Switzerland.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gargiulo
authors.affiliation: Cardiology Department, Inselspital University Hospital, Bern, Switzerland.
authors.forename: Fabien
authors.initials: F
authors.lastname: Praz
authors.affiliation: Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.affiliation: Hospital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Cardiology Department, Galway University Hospital, Galway, Ireland.
authors.forename: Darren
authors.initials: D
authors.lastname: Mylotte
authors.affiliation: Institut cardio-pneumologique, CHRU, Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Debry
authors.affiliation: Cardiology Department, Ferrarotto Hospital, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Hospital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.affiliation: Institut cardio-pneumologique, CHRU, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
authors.affiliation: Interventional Cardiology, University Hospital, Antwerp, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Bosmans
authors.affiliation: Cardiology Department, Inselspital University Hospital, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Interventional Cardiology, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Israel
authors.initials: I
authors.lastname: Barbash
authors.affiliation: Cardiology Department, Bonn University Hospital, Bonn, Germany.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.affiliation: Cardiology Department, Bonn University Hospital, Bonn, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.affiliation: Cardiology Department, Rabin Medical Center, Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Barsheshet
authors.affiliation: Cardiology Department, Rabin Medical Center, Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: ran.kornowski@gmail.com.
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D005060:Europe; D005260:Female; D005919:Glomerular Filtration Rate; D006470:Hemorrhage; D006801:Humans; D007557:Israel; D007564:Japan; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D016017:Odds Ratio; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome