In the Journals

Fewer adverse outcomes in chronic kidney disease in TAVR vs. surgery

Nilay Kumar, MD
Nilay Kumar

Patients with chronic kidney disease who underwent transcatheter aortic valve replacement had better outcomes compared with those who underwent surgical AVR, according to a study published in The American Journal of Cardiology.

Those who had TAVR had decreased risk for in-hospital mortality, postoperative stroke, overall acute kidney injury and acute kidney injury requiring dialysis compared with those who had surgical AVR, researchers reported.

Nilay Kumar, MD, clinical assistant professor in the division of hospital medicine at University of Wisconsin School of Medicine and Public Health in Madison, and colleagues analyzed data from patients with any diagnosis of chronic kidney disease from the 2011-2014 National Inpatient Sample. They compared patients who underwent TAVR (n = 2,820; mean age, 83 years; 40% women) vs. those who had surgical AVR (n = 4,054; mean age, 74 years; 35% women). Those who underwent concomitant procedures such as CABG and aortic root replacement were excluded.

The coprimary outcomes of interest were in-hospital mortality, postoperative stroke, acute kidney injury and acute kidney injury requiring dialysis. Secondary outcomes of interest included length of stay and cost.

Compared with surgical AVR, patients who underwent TAVR had lower rates of in-hospital mortality (OR = 0.47; 95% CI, 0.32-0.69), postoperative stroke (OR = 0.27; 95% CI, 0.13-0.53) acute kidney injury (OR = 0.18; 95% CI, 0.14-0.22) and acute kidney injury requiring dialysis (OR = 0.3; 95% CI, 0.2-0.44).

Patients who underwent surgical AVR or TAVR were matched (n = 1,001). In these propensity-matched pairs, the TAVR group had lower rates of postoperative stroke (OR = 0.46; 95% CI, 0.2-0.98), acute kidney injury (OR = 0.39; 95% CI, 0.32-0.46), in-hospital mortality (OR = 0.67; 95% CI, 0.45-0.99) and acute kidney injury requiring dialysis (OR = 0.53; 95% CI, 0.35-0.81), as well as a shorter length of stay (OR = 0.35; 95% CI, 0.29-0.42). There was no significant difference in cost between the two groups (OR = 1.05; 95% CI, 0.88-1.26).
“These findings underscore the need to identify and implement renal protective strategies in patients with [chronic kidney disease] undergoing AVR, including minimizing blood loss, limiting contrast volume, aggressive and timely management of hemodynamic instability and minimizing time spent on cardiopulmonary bypass,” Kumar and colleagues wrote. – by Darlene Dobkowski

Disclosure s : Kumar reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Nilay Kumar, MD
Nilay Kumar

Patients with chronic kidney disease who underwent transcatheter aortic valve replacement had better outcomes compared with those who underwent surgical AVR, according to a study published in The American Journal of Cardiology.

Those who had TAVR had decreased risk for in-hospital mortality, postoperative stroke, overall acute kidney injury and acute kidney injury requiring dialysis compared with those who had surgical AVR, researchers reported.

Nilay Kumar, MD, clinical assistant professor in the division of hospital medicine at University of Wisconsin School of Medicine and Public Health in Madison, and colleagues analyzed data from patients with any diagnosis of chronic kidney disease from the 2011-2014 National Inpatient Sample. They compared patients who underwent TAVR (n = 2,820; mean age, 83 years; 40% women) vs. those who had surgical AVR (n = 4,054; mean age, 74 years; 35% women). Those who underwent concomitant procedures such as CABG and aortic root replacement were excluded.

The coprimary outcomes of interest were in-hospital mortality, postoperative stroke, acute kidney injury and acute kidney injury requiring dialysis. Secondary outcomes of interest included length of stay and cost.

Compared with surgical AVR, patients who underwent TAVR had lower rates of in-hospital mortality (OR = 0.47; 95% CI, 0.32-0.69), postoperative stroke (OR = 0.27; 95% CI, 0.13-0.53) acute kidney injury (OR = 0.18; 95% CI, 0.14-0.22) and acute kidney injury requiring dialysis (OR = 0.3; 95% CI, 0.2-0.44).

Patients who underwent surgical AVR or TAVR were matched (n = 1,001). In these propensity-matched pairs, the TAVR group had lower rates of postoperative stroke (OR = 0.46; 95% CI, 0.2-0.98), acute kidney injury (OR = 0.39; 95% CI, 0.32-0.46), in-hospital mortality (OR = 0.67; 95% CI, 0.45-0.99) and acute kidney injury requiring dialysis (OR = 0.53; 95% CI, 0.35-0.81), as well as a shorter length of stay (OR = 0.35; 95% CI, 0.29-0.42). There was no significant difference in cost between the two groups (OR = 1.05; 95% CI, 0.88-1.26).
“These findings underscore the need to identify and implement renal protective strategies in patients with [chronic kidney disease] undergoing AVR, including minimizing blood loss, limiting contrast volume, aggressive and timely management of hemodynamic instability and minimizing time spent on cardiopulmonary bypass,” Kumar and colleagues wrote. – by Darlene Dobkowski

Disclosure s : Kumar reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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