B-43 | TAVR in End-Stage Renal Disease Patients: Long-Term Outcomes, Structural Valve Degeneration and Need for Aortic Valve Reintervention

Abstract

ESRD patients are predisposed to the development of calcific aortic valve disease. Patients with ESRD were excluded from the clinical trials of TAVR, and hence long-term outcomes are not well established. We sought to describe the long-term outcomes, including incidence of structural valve degeneration (SVD) and re-intervention, in patients with ESRD undergoing TAVR at our institution. Retrospective registry of consecutive patients with ESRD who underwent TAVR for aortic stenosis at our institution (2012-present). Variables of interest included patient demographics, clinical and procedural characteristics. Outcomes assessed were in-hospital events, SVD, aortic re-intervention procedures, and standard MACE incidence at 30-days, 6-months, 1-year, and at annual follow-ups. Our study included 95 patients with ESRD who underwent TAVR. In-hospital events were notable for new permanent pacemaker placement (12.6%), cardiac arrest (5.3%), and mortality (6.3%). The long-term all-cause mortality was 47.4%, with survival time after TAVR of 596 days. The most common long-term MACE was MI (7.4%). Long-term SVD occurred in 25 cases (26.3%). Long-term re-intervention occurred in 3 cases (3.2%). In-hospital and long-term MACE were high; however, when looking at baseline STS scores, these rates were close to expected. SVD was elevated with over one-fourth of patients demonstrating some degree for degeneration; however, only 3.2% of patients required re-intervention. To the best of our knowledge, this is the only study characterizing long-term SVD and re-intervention rates in this population.