TY - JOUR AU - Ruge, Hendrik AU - Deutsch, Marcus-André AU - Erlebach, Magdalena AU - Burri, Melchior AU - Bleiziffer, Sabine AU - Lange, Ruediger PY - 2020/08/28 Y2 - 2024/03/28 TI - TAVR in Patients on Hemodialysis: Outcome of A High-Risk Patient Group JF - The Heart Surgery Forum JA - HSF VL - 23 IS - 5 SE - DO - 10.1532/hsf.3129 UR - https://journal.hsforum.com/index.php/HSF/article/view/3129 SP - E611-E616 AB - <p class="p1"><span class="s1"><strong>Background:</strong> Perioperative mortality is high and long-term survival is poor for patients on hemodialysis undergoing surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) offers a safe and effective therapy for high-risk patients suffering from aortic valve stenosis. However, in patients on hemodialysis only limited information is available on the outcome following TAVR.</span></p><p class="p1"><span class="s1"><strong>Methods:</strong> Of the 2613 consecutive patients in our single-center TAVR registry, all hemodialysis patients, were identified. Demographics, procedural details, clinical outcomes, mortality, and complications were evaluated.</span></p><p class="p1"><span class="s2"><strong>Results:</strong> Forty-two hemodialysis patients with a mean age of 75.2±8.2 years, a mean STS predicted risk of mortality of 11.1±9.5% and a mean logEuroScore of 27.9±18.8% underwent TAVR. Mean duration on hemodialysis prior to intervention was 62.8±49.6 months. A transfemoral access was chosen in 24 patients, a transapical in 16, and a transaxillary and a transaortic in one patient, respectively. Estimated survival at 30 days, one, three and five years was 83.3%, 68.3%, 37.7% and 18.9%, respectively. Estimated median survival was 1.8±0.4 years. VARC-2 defined perioperative complications included stroke in 7.1% (3/42), major bleeding in 16.7% (7/42), and vascular complications in 7.1% (3/42). In two patients, echocardiographic examination at three and four years, respectively, showed evidence for structural valve deterioration.</span></p><p class="p1"><span class="s1"><strong>Conclusion:</strong> A high number of patients with ESRD undergoing TAVR require a non-transfemoral access. <br />Predominantly, bleeding events contribute to the perioperative morbidity. An estimated median survival of less than two years after TAVR allows only limited assessment of valve prosthesis durability. Cardiovascular and non-cardiovascular mortality contribute equally to the causes of death beyond the first year after TAVR.</span></p> ER -