Propensity matched comparison of TAVI and SAVR in intermediate-risk patients with severe aortic stenosis and moderate-to-severe chronic kidney disease: a subgroup analysis from the German Aortic Valve Registry

Medientyp: E-Artikel
Titel: Propensity matched comparison of TAVI and SAVR in intermediate-risk patients with severe aortic stenosis and moderate-to-severe chronic kidney disease: a subgroup analysis from the German Aortic Valve Registry
Beteiligte: Mas-Peiro, Silvia; Faerber, Gloria; Bon, Dimitra; Herrmann, Eva; Bauer, Timm; Bleiziffer, Sabine; Bekeredjian, Raffi; Böning, Andreas; Frerker, Christian; Beckmann, Andreas; Möllmann, Helge; Ensminger, Stephan; Hamm, Christian W.; Beyersdorf, Friedhelm; Fichtlscherer, Stephan; Walther, Thomas
Erschienen: Springer Science and Business Media LLC, 2022
Erschienen in: Clinical Research in Cardiology, 111 (2022) 12, Seite 1387-1395
Sprache: Englisch
DOI: 10.1007/s00392-022-02083-2
ISSN: 1861-0684; 1861-0692
Schlagwörter: Cardiology and Cardiovascular Medicine ; General Medicine
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Beschreibung: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Objective</jats:title> <jats:p>We compared TAVI vs. SAVR in patients with moderate-to-severe chronic kidney disease (eGFR 15–60 ml/min/1.73 m<jats:sup>2</jats:sup>) for whom both procedures could possibly be considered (age ≤ 80 years, STS-score 4–8).</jats:p> </jats:sec><jats:sec> <jats:title>Background</jats:title> <jats:p>According to both ACC/AHA and ESC/EACTS recent guidelines, aortic stenosis may be treated with either transcatheter (TAVI) or surgical (SAVR) aortic valve replacement in a subgroup of patients. A shared therapeutic decision is made by a heart team based on individual factors, including chronic kidney disease (CKD).</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Data from the large nationwide German Aortic Valve Registry were used. A propensity score method was used to select 704 TAVI and 374 SAVR matched patients. Primary endpoint was 1-year survival. Secondary endpoints were clinical complications, including pacemaker implantation, vascular complications, myocardial infarction, bleeding, and the need for new-onset dialysis.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>One-year survival was similar (HR [95% CI] for TAVI 1.271 [0.795, 2.031], <jats:italic>p</jats:italic> = 0.316), with no divergence in Kaplan–Meier curves. In spite of post-procedural short-term survival being numerically higher for TAVI patients and 1-year survival being numerically higher for SAVR patients, such differences did not reach statistical significance (96.4% vs. 94.2%, <jats:italic>p</jats:italic> = 0.199, and 86.2% vs. 81.2%, <jats:italic>p</jats:italic> = 0.316, respectively). In weighted analyses, pacemaker implantation, vascular complications, and were significantly more common with TAVI; whereas myocardial infarction, bleeding requiring transfusion, and longer ICU-stay and overall hospitalization were higher with SAVR. Temporary dialysis was more common with SAVR (<jats:italic>p</jats:italic> < 0.0001); however, a probable need for chronic dialysis was rare and similar in both groups.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Both TAVI and SAVR led to comparable and excellent results in patients with moderate-to-severe CKD in an intermediate-risk population of patients with symptomatic severe aortic stenosis for whom both therapies could possibly be considered.</jats:p> </jats:sec>

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