Abstract 11266: Trend, Predictors and Outcomes of Transcatheter Aortic Valve Implantation in Patients With End-Stage Renal Disease: Insights From the Nationwide Readmissions Database

Abstract

Background: Evidence on the safety of transcatheter aortic valve implantation (TAVI) in End-stage renal disease (ESRD) patients is limited. Methods: The Nationwide Readmissions Database (NRD) from 2015-2019 was queried to identify patients undergoing TAVI in ESRD versus patients with no ESRD. The in-hospital, 30-day, and 180-day outcomes were assessed using a propensity-score matched (PSM) analysis to calculate adjusted odds ratios (aOR). Results: A total of 198,816 underwent TAVI, of which 34,546 patients (TAVI-ESRD:16,986 vs non-ESRD:17,560) were selected on PSM analysis. The adjusted odds of net adverse cardiovascular events (NACE) (aOR 1.65, 95% CI 1.49-1.82), in-hospital mortality (aOR 2.99, 95% CI 2.52-3.55), major bleeding (aOR 1.21, 95% CI 1.05-1.40), postprocedural cardiogenic shock (aOR 1.54, 95% CI 1.11-2.13), permanent pacemaker implantation (PPM) (aOR 1.24, 95% CI 1.15-1.38) were significantly higher in TAVI-ESRD patients compared with non-ESRD patients at index admission. There was no significant difference in the odds of stroke (aOR 1.09, 95% CI 0.86-1.34) and cardiac tamponade (aOR 1.06, 95% CI 0.78-1.45) between two groups. Table 1. At 30-day follow-up, TAVI-ESRD patients had higher odds of major bleeding while there was no significant difference in outcomes of stroke, cardiac tamponade and PPM implantation between the two groups up to 180-day follow-up, Table 2. On trend analysis, the rate of utilization of TAVI in ESRD has significantly increased to 30% by 2019. Conclusion: The rate of utilization of TAVI in ESRD has significantly increased in recent years despite the higher risk of NACE, in-hospital mortality, major bleeding and PPM implantation.