title: End-stage renal disease and severe aortic stenosis: Does valve replacement improve one-year outcomes?
abstract: BACKGROUND
  Treatment for patients with end-stage renal disease (ESRD) and severe aortic stenosis (AS) includes balloon aortic valvuloplasty (BAV), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement. We compared outcomes among these strategies.
  
  
  METHODS
  A retrospective review of patients with ESRD undergoing treatment for severe AS between 07/2007 and 06/2015 was performed at our center. Patients were classified based on treatment: BAV-only, TAVR, or SAVR. Baseline characteristics and 30-day outcomes were compared among groups. A 1-year survival analysis was performed.
  
  
  RESULTS
  Of 85 patients, 25 (29.4%) underwent BAV, 30 (35.3%) TAVR, and 30 (35.3%) SAVR. Patients in the SAVR group, compared to the BAV or TAVR patients, were younger (63 vs. 74 vs. 71 years, P = 0.02) and had less prior stroke (3.3% vs. 12.0% vs. 30.0%, P = 0.008). While all BAV patients had NYHA class III/IV, 93.3% and 76.7% of patients had NYHA class III/IV in the TAVR and SAVR group, respectively (P = 0.001). BAV patients were less likely to have atrial fibrillation than TAVR or SAVR patients (16.0% vs. 43.3% vs. 50.0%, P = 0.03). All patients were high risk, but there was a statistical trend to lower STS scores in the SAVR group (8.6% vs. 13.5% vs. 13.5%, P = 0.08). There was no significant difference in 30-day mortality (16.7% vs. 10.0% vs. 10.0%, P = 0.74), but BAV treated patients had an increased 1-year mortality compared to those treated with TAVR or SAVR (87.0% vs. 32.0%, vs. 36.7%, P=<0.001). Independent predictors of 1-year mortality were a higher STS score (HR 1.026, 95%CI 1.002-1.051) and BAV-only strategy (BAV vs. TAVR: HR 3.961, 95%CI 1.595-9.840), but dialysis duration and type, and SAVR versus TAVR were not.
  
  
  CONCLUSIONS
  Patients with ESRD and severe AS have a similar and higher survival with TAVR or SAVR when compared to BAV at 1-year. These results may influence patient care decisions favoring valve replacement in AS patients with ESRD. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Condado
authors.affiliation: Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Aneel
authors.initials: A
authors.lastname: Maini
authors.affiliation: Divisions of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Bradley
authors.initials: B
authors.lastname: Leshnower
authors.affiliation: Divisions of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vinod
authors.initials: V
authors.lastname: Thourani
authors.affiliation: Divisions of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Forcillo
authors.affiliation: Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Chandan
authors.initials: C
authors.lastname: Devireddy
authors.affiliation: Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Kreton
authors.initials: K
authors.lastname: Mavromatis
authors.affiliation: Divisions of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Sarin
authors.affiliation: Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: James
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Divisions of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Robert
authors.initials: R
authors.lastname: Guyton
authors.affiliation: Divisions of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Amy
authors.initials: A
authors.lastname: Simone
authors.affiliation: Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Keegan
authors.affiliation: Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
authors.affiliation: Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Block
authors.affiliation: Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: aortic stenosis; aortic valve replacement; end-stage renal disease on dialysis