Abstract 15120: Chronic Renal Failure Represents an Independent Predictor for Worse Outcome After Transfemoral Aortic Valve Replacement
Background: Transfemoral Aortic Valve Implantation (TAVI) is an established treatment for high-risk surgical patients with symptomatic aortic valve stenosis (AS). Many of these pts present with chronic renal failure (CRF). Information about outcome of TAVI pts with CRF is scarce.
Aim of the study: Therefore the aim of this study was to investigate the clinical outcome of TAVI pts with and without CRF.
Methods: 106 patients with CRF underwent TAVI at our hospital using the CoreValve Revalving system (26/29/31mm). 141 patients with normal renal function (NRF) served as a control group. After individual heart team decision, the stenosed aortic valve was treated using the CoreValve prothesis. It was implanted under local anesthesia using the retrograde transfemoral route (18F) exclusively. The pts were followed up clinically and by echocardiography.
Results: At our hospital 106 pts with CRF (mean age 82.7±0.6 [SEM] years, mean log Euro-Score 28.3±1.3%, average mean pressure gradient 41.24±1.3 mmHg, mean left ventricular function (LVEF) 50.9±1.0 %, mean GFR 80.7±1,5, mean BNP 1773,0±298.2) and 141 patients with NRF (mean age 79.9±0.6 years, mean log Euro-Score 21.3±0,9%, average mean pressure gradient 46.4± 3.2 mmHg, mean LVEF 51.2±1.0 %, mean GFR 80.7±1,5, mean BNP 781.2±101.9) underwent successful TAVI using the CoreValve device. Periprocedural-in-cath-mortality was 0% in both groups. After 30-days all-cause mortality was 4.9% in all patients (NRF 1.4%, CRF 9.4%, p=0.004). Long-term survival was significantly better in patients with NRF than in patients with CRF, resulting in a 1-year mortality of 22.6% in pts with CRF compared to 8,5% in the control group (NRF). In a multivariate logistic regression analysis including age, Euroscore, left ventricular ejection fraction, low gradient aortic stenosis, and CRF, only CRF turned out to be an independent predictor for all-cause mortality.
Conclusion: TAVI shows excellent acute and intermediate results in patients with normal renal function. Pts. with CRF have a 6.7-fold increased 30-day mortality and 2.7-fold increase in long-term mortality after successful TAVI. CRF is an independent predictor for all-cause mortality after TAVI.
- © 2013 by American Heart Association, Inc.