Accelerated rate of progression of bioprosthetic aortic stenosis in patients with renal disease.

Abstract

Renal disease can lead to more rapid progression of aortic stenosis. However, there are limited case report data investigating the impact of renal disease on the rate of prosthetic aortic valve stenosis. We sought to quantify the rate of progression of bioprosthetic aortic stenosis in patients with renal disease. Patients with bioprosthetic aortic valves and at least two transthoracic echocardiograms six or more months apart were included. Echocardiographic data from patients with end-stage renal disease (ESRD), chronic kidney disease (CKD) stages 3-4, and normal renal function were compared using ANOVA and Kruskal-Wallis tests. One hundred fifteen patients (43 ESRD, 52 CKD, and 20 controls) were included in this study. Changes in dimensionless index (DI) (units/year) for patients with normal renal function, CKD, and ESRD were .025 ± .13, -.040 ± .08, -.10 ± .13, respectively, leading to calculated changes in aortic valve area (AVA) (cm2 /year) of .04 ± .28, -.13 ± .29, -.42 ± .72, respectively.Change in peak gradient (m/sec/year) was significantly lower for patients with normal renal function compared to ESRD; -.077 ± 5.98 versus 7.18 ± 17.9. In the ESRD group, a nonsignificant trend toward greater change in DI/year was seen in TAVR compared to SAVR: -.14 ± .16 versus -.08 ± .11. Our results confirm limited available data reporting an accelerated rate of bioprosthetic stenosis in patients with CKD and ESRD. These data not only quantify this progression but may also inform clinical decision-making and valve selection in patients with renal disease.