Abstract 14430: 5-year Outcomes After Transcatheter & Surgical Aortic Valve Replacement in Advanced Chronic Kidney Disease Patients

Abstract

Introduction: Advanced chronic kidney disease (CKD4,5) patients are known to have increased morbidity and mortality when undergoing surgical procedures. While short term outcomes among patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR) have been studied, research assessing long term outcomes are scant. Therefore, the goal was to assess 5-year outcomes for these patients undergoing TAVR or SAVR. Methods: A retrospective cohort study was done using TriNetX, a national federated real time database of 69 million records. Patient cohorts were identified if they met the criteria for CKD and underwent TAVR or SAVR up until May 2016 for 5 year follow up. A 1:1 matched propensity score analysis was conducted, adjusting for comorbidities and demographics, to calculate adjusted Risk Ratios (aRR) with 95% confidence intervals (CI) for complications of interest. Kaplan Meir (KM) analysis was done to calculate survival probability in 5 years among the 2 cohorts. Results: In a matched sample of 355 patients in each cohort, the TAVR did not show any significant differences in mortality (RR[CI]): (1.07[0.89-1.28]) compared to the SAVR Group. However, KM analysis revealed a significantly lower 5-year survival probability compared to the SAVR group (p<0.035). There were no statistically significant differences among the 2 cohorts in other assessed long-term complications such as stroke (0.67[0.42-1.05]) and new pacemaker placement (1.31[0.81-2.17]). However, redo TAVR/SAVR was higher in the TAVR cohort than the SAVR cohort (3.1[1.54-6.23]). Conclusions: 5-year mortality appears to be similar in advanced CKD patients but repeat TAVR/SAVR were much higher suggesting decreased longevity of TAVR valves in this population.