Abstract 15410: Transcatheter Aortic Valve Implantation in Dialysis Patients: Similar Outcome Compared to Conventional Biological or Mechanical Prosthesis at 5 Years
Objectives: Long term durability of transcatheter aortic valves (TAVI) remains a key issue in this rapidly growing field. We reasoned that if durability of TAVI is limited, it should show first in patients with high appearance rates of structural valve deterioration.
Methods: We analyzed all our chronic dialysis patients (n=103) who underwent aortic valve replacement with either mechanical (mech: n=31), biological (bio: n=54) or TAVI (n=18) prostheses between 2001 and 2014.
Results: TAVI patients were oldest (76±6.6 years vs. bio 71±7.5 vs. mech 59±12.5; p<0.05), had the highest rate of coronary artery disease (78% vs. bio 54% vs. mech 54%; n.s.) and diabetes (72% vs. bio 37% vs. mech 42%; p<0.05). Endocarditis was present in the conventional group only (bio 9%, mech 16%). ReOP were most frequent in the TAVI group (28% vs. bio 6% vs. mech 9%). Euroscores were 37±24% for TAVI, 24±20 for biological and 16±18% for mechanical (p<0.005). Mortality (30d) was lowest for patients with biological valves (7%) compared with mechanical valves (26%) or TAVI (22%; p<0.05). Survival at 5years was identical in all groups (Kaplan-Meyer survival see figure). Mulitvariate analysis did not reveal any differences between the groups. Reoperations were required for structural valve deterioration (SVD) in two cases after conventional biological valve replacement and in two patients with mechanical valves for endocarditis or prosthesis refixation. There was no reoperation in the TAVI group and follow up echocardiography did not reveal signs for SVD. The conventional tissue valves showed the highest gradients (Pmean [mmHg]: bio 20±12.5 vs. mech 10±2.6 vs. TAVI 12±2.8; p<0.05). SF-36 survey revealed less bodily pain and better social functioning in the TAVI patients.
Conclusions: The results suggest that using transcatheter bioprostheses in dialysis patients does not negatively affect outcome at 5-years and durability may not be worse than with conventional tissue valves.
Author Disclosures: G. Faerber: None. K. Abdyvasiev: None. A. Lauten: None. M. Breuer: None. M. Diab: None. H.R. Figulla: None. T. Doenst: None.
- © 2014 by American Heart Association, Inc.