Abstract 18793: Impact of Chronic Kidney Disease on Outcomes in Patients Undergoing Balloon Aortic Valvuloplasty: Results from the BRAVO Study
Background Balloon aortic valvuloplasty (BAV) is a palliative treatment for severe aortic stenosis that is increasingly performed as a bridge to transcatheter aortic valve replacement. While chronic kidney disease (CKD) is a frequent comorbidity in elderly patients with aortic stenosis undergoing BAV, its impact on in-hospital outcomes has not yet been determined.
Methods We conducted a retrospective analysis of 421 consecutive patients who underwent non-emergent BAV at two high-volume centers. We analyzed baseline and procedural characteristics as well as in-hospital outcomes according to the presence or absence of CKD, defined as a glomerular filtration rate of <60 mL/min/1.73m2. All adverse events were adjudicated by a blinded, independent clinical events committee.
Results Of the 421 patients who underwent BAV, 251 (59.2%) had CKD. Patients with CKD had significantly higher rates of mortality (8.0% vs. 2.4%, p=0.02) and major bleeding (14.3% vs. 7.6%, p=0.04) as well as net adverse clinical events (18.7% vs. 11.2%, p=0.04) compared to patients without CKD. A secondary analysis stratifying the groups by type of antithrombotic used revealed an almost 3-fold decrease in major bleeding events in CKD patients treated with bivalirudin compared to those receiving heparin (5.8% vs. 14.9%, p=0.01). After multivariate analysis controlling for multiple confounders, CKD remained associated with an increased risk for bleeding (OR 1.99; 95%CI [0.83, 4.78]; p=0.12) and death (OR 2.12; 95%CI [0.61, 7.33]; p=0.24), without statistical significance.
Conclusions CKD is associated with an increased risk of in-hospital mortality and bleeding complications post-BAV. Further research is warranted to determine whether adverse outcomes in CKD patients can be reduced through selective use of novel devices or alternative pharmacological approaches.
- © 2012 by American Heart Association, Inc.