Comparison of Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Chronic Kidney Disease

Nilay Kumar, Rohan Khera, Neetika Garg, Justin Echouffo Tcheugui, Anand Venkatraman, Ambarish Pandey, Deepak L. Bhatt

Research output: Contribution to journalArticle

Abstract

There are few data comparing outcomes of transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in patients with chronic kidney disease. In this retrospective cohort study using the National Inpatient Sample 2011 to 2014, we included a total of 2,820 TAVI and 4,054 SAVR procedures, representative of 14,039 TAVI and 19,835 SAVR procedures nationally. Co-primary outcomes were in-hospital mortality, acute kidney injury (AKI), dialysis-requiring AKI, and postoperative stroke. In multivariate analysis, TAVI was associated with a lower in-hospital mortality (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.32 to 0.69, p < 0.001), rates of AKI (OR 0.18, 95% CI 0.14 to 0.22, p < 0.001), dialysis-requiring AKI (OR 0.30, 95% CI 0.20 to 0.44, p < 0.001), and postoperative stroke (OR 0.27, 95% CI 0.13 to 0.53, p < 0.001) compared with SAVR. In 1001 propensity-matched pairs of TAVI and SAVR procedures, TAVI was associated with lower in-hospital mortality (OR 0.67, 95% CI 0.45 to 0.99, p = 0.047) rates of AKI (OR 0.39, 95% CI 0.32 to 0.46, p < 0.001), dialysis-requiring AKI (OR 0.53, 95% CI 0.35 to 0.81, p < 0.001), postoperative stroke (OR 0.46, 95% CI 0.20 to 0.98, p = 0.045), significantly shorter length of stay (OR 0.35, 95% CI 0.29 to 0.42, p < 0.001), and nonsignificant difference in cost (OR 1.05, 95% CI 0.88 to 1.26, p = 0.57) compared with SAVR. In conclusion, TAVI may be a preferable approach to SAVR in patients with severe aortic stenosis in the setting of chronic kidney disease.

Original languageEnglish (US)
Pages (from-to)343-348
Number of pages6
JournalAmerican Journal of Cardiology
Volume121
Issue number3
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

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Aortic Valve
Chronic Renal Insufficiency
Surgical Instruments
Odds Ratio
Confidence Intervals
Acute Kidney Injury
Hospital Mortality
Dialysis
Stroke
Aortic Valve Stenosis
Transcatheter Aortic Valve Replacement
Inpatients
Length of Stay
Cohort Studies
Multivariate Analysis
Retrospective Studies
Costs and Cost Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Chronic Kidney Disease. / Kumar, Nilay; Khera, Rohan; Garg, Neetika; Echouffo Tcheugui, Justin; Venkatraman, Anand; Pandey, Ambarish; Bhatt, Deepak L.

In: American Journal of Cardiology, Vol. 121, No. 3, 01.02.2018, p. 343-348.

Research output: Contribution to journalArticle

Kumar, Nilay ; Khera, Rohan ; Garg, Neetika ; Echouffo Tcheugui, Justin ; Venkatraman, Anand ; Pandey, Ambarish ; Bhatt, Deepak L. / Comparison of Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Chronic Kidney Disease. In: American Journal of Cardiology. 2018 ; Vol. 121, No. 3. pp. 343-348.
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abstract = "There are few data comparing outcomes of transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in patients with chronic kidney disease. In this retrospective cohort study using the National Inpatient Sample 2011 to 2014, we included a total of 2,820 TAVI and 4,054 SAVR procedures, representative of 14,039 TAVI and 19,835 SAVR procedures nationally. Co-primary outcomes were in-hospital mortality, acute kidney injury (AKI), dialysis-requiring AKI, and postoperative stroke. In multivariate analysis, TAVI was associated with a lower in-hospital mortality (odds ratio [OR] 0.47, 95{\%} confidence interval [CI] 0.32 to 0.69, p < 0.001), rates of AKI (OR 0.18, 95{\%} CI 0.14 to 0.22, p < 0.001), dialysis-requiring AKI (OR 0.30, 95{\%} CI 0.20 to 0.44, p < 0.001), and postoperative stroke (OR 0.27, 95{\%} CI 0.13 to 0.53, p < 0.001) compared with SAVR. In 1001 propensity-matched pairs of TAVI and SAVR procedures, TAVI was associated with lower in-hospital mortality (OR 0.67, 95{\%} CI 0.45 to 0.99, p = 0.047) rates of AKI (OR 0.39, 95{\%} CI 0.32 to 0.46, p < 0.001), dialysis-requiring AKI (OR 0.53, 95{\%} CI 0.35 to 0.81, p < 0.001), postoperative stroke (OR 0.46, 95{\%} CI 0.20 to 0.98, p = 0.045), significantly shorter length of stay (OR 0.35, 95{\%} CI 0.29 to 0.42, p < 0.001), and nonsignificant difference in cost (OR 1.05, 95{\%} CI 0.88 to 1.26, p = 0.57) compared with SAVR. In conclusion, TAVI may be a preferable approach to SAVR in patients with severe aortic stenosis in the setting of chronic kidney disease.",
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N2 - There are few data comparing outcomes of transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in patients with chronic kidney disease. In this retrospective cohort study using the National Inpatient Sample 2011 to 2014, we included a total of 2,820 TAVI and 4,054 SAVR procedures, representative of 14,039 TAVI and 19,835 SAVR procedures nationally. Co-primary outcomes were in-hospital mortality, acute kidney injury (AKI), dialysis-requiring AKI, and postoperative stroke. In multivariate analysis, TAVI was associated with a lower in-hospital mortality (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.32 to 0.69, p < 0.001), rates of AKI (OR 0.18, 95% CI 0.14 to 0.22, p < 0.001), dialysis-requiring AKI (OR 0.30, 95% CI 0.20 to 0.44, p < 0.001), and postoperative stroke (OR 0.27, 95% CI 0.13 to 0.53, p < 0.001) compared with SAVR. In 1001 propensity-matched pairs of TAVI and SAVR procedures, TAVI was associated with lower in-hospital mortality (OR 0.67, 95% CI 0.45 to 0.99, p = 0.047) rates of AKI (OR 0.39, 95% CI 0.32 to 0.46, p < 0.001), dialysis-requiring AKI (OR 0.53, 95% CI 0.35 to 0.81, p < 0.001), postoperative stroke (OR 0.46, 95% CI 0.20 to 0.98, p = 0.045), significantly shorter length of stay (OR 0.35, 95% CI 0.29 to 0.42, p < 0.001), and nonsignificant difference in cost (OR 1.05, 95% CI 0.88 to 1.26, p = 0.57) compared with SAVR. In conclusion, TAVI may be a preferable approach to SAVR in patients with severe aortic stenosis in the setting of chronic kidney disease.

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