Aortic Stenosis Patients With Transcatheter Aortic Valve Replacement: Caution Recommended With Renal Failure During Hospitalization.

Pawandeep Kaur,Temitope Ajibawo,Timiiye Yomi,Rikinkumar S Patel,Mizba Baksh,Saurabh Kataria,Edmond Okotcha,Neev Patel

doi:10.7759/cureus.9384

Abstract

ObjectiveOur study aimed to assess the risk of in-patient mortality due to renal failure and other comorbidities in aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR).MethodsWe conducted a cross-sectional study using a Nationwide Inpatient Sample (NIS, January 2010 to December 2014) from the United States and included 33,325 patients with a primary diagnosis of AS. Logistic regression was used to evaluate the odds ratio (OR) for in-hospital mortality in AS by comorbidities including renal failure.ResultsThe prevalence of renal failure in AS patients is 29.2%, and a higher proportion were males (60.1%) and non-white (14.1%). Major loss of function (96.6%) and in-hospital mortality (5.1%) were also proportionally higher in prevalence. Female patients (OR 1.35, 95% CI 1.20-1.51) had higher odds of in-patient mortality in AS patients. Race was a non-significant predictor for mortality risk. Patients with comorbid coagulopathy (OR 2.02, 95% CI 1.79-2.27) and heart failure (OR 1.62, 95% CI 1.39-1.89) have increased mortality in AS inpatients. After controlling confounders, renal failure was significantly associated with increased in-hospital mortality (OR 1.43, 95% CI 1.28-1.61) in AS patients.ConclusionRenal failure was prevalent in AS patients and was an independent factor that increases the risk of in-hospital mortality by 43%. Due to worse outcomes, more studies are required to evaluate risk-benefit ratio and strategies to improve health-related quality of life in post-TAVR patients with renal failure, and optimally decrease inpatient mortality.

Highlights

Aortic stenosis (AS) is a common valvular abnormality and is ranked as the third most common cardiovascular disease
Renal failure was significantly associated with increased inhospital mortality in aortic stenosis (AS) patients
Renal failure was prevalent in AS patients and was an independent factor that increases the risk of inhospital mortality by 43%

Summary

Introduction

Aortic stenosis (AS) is a common valvular abnormality and is ranked as the third most common cardiovascular disease. Prevalence is around 0.4% and about 1.7% in the elderly population above 65 years of age [1]. A rise in prevalence is seen in AS with increasing age with about 4% of elderly aged above 85 years are affected by worsening aortic sclerosis and AS. Some of the factors associated with the progression of AS are older age, cigarette smoking, and comorbidities like hypertension, obesity, diabetes, dyslipidemia, chronic renal disease, atherosclerosis, and coronary artery disease (CAD). Other hemodynamic-related factors (left ventricular systolic dysfunction and/or low cardiac output), and aortic valve-related factors like a bicuspid aortic valve, degenerative AS, valve calcification and regurgitation worsen the disease process [2].

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