Dr Isabel Scalia1, Dr Dharmenaan Palamuthusingam1, Prof Carmel Hawley2, Ms Elaine Pascoe7, Prof David Johnson2, Dr Sam Hayman1, Dr Palvannan Sivalingam6, Dr Stephen McDonald5, Prof Neil Boudville9, Dr Matthew Jose3, Dr Prianka Puri1, A/Prof Girish Talaulikar4, Dr Magid Fahim2
1Department of Nephrology, Royal Brisbane And Women’s Hospital, Brisbane, Australia, 2 Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital,, Brisbane, Australia, 3Department of Nephrology, Royal Hobart Hospital, Hobart, Australia, 4Renal Services, ACT Health, Canberra, Australia, 5Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 6Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Australia, 7Centre for Health Services Research, University of Queensland, Brisbane, Australia, 8Canterbury District Health Board, Canterbury, New Zealand, 9Faculty of Medicine, University of Western Australia, Stirling Highway, Western Australia
Background:
TAVR is increasingly being considered as an alternative to surgical aortic valve replacement in patients on chronic dialysis who are considered high operative risk. This bi-national data-linkage study describes the clinical outcomes following TAVR between 2008 and 2015.
Methods:
Data-linkage between Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets was used to evaluate outcomes for all incident and prevalent patients receiving chronic dialysis between 2008 and 2015 who underwent a TAVR as defined by the Australian Classification of Health Interventions. Descriptive statistics were used to describe baseline characteristics and outcomes.
Results:
Nineteen in-centre haemodialysis patients underwent TAVR with a median follow-up of 1.5yrs[1.1-2.4], 14(74%) were male, median age, dialysis vintage and BMI were 76.4yrs[70.4-80.2], 4.4yrs[1.4-8.4] and 27.3kg/m2[21.6-28.7], respectively. No patients were on peritoneal or home-haemodialysis, and no procedures were performed in New Zealand. Twelve of the procedures occurred in 2015. No patients had undergone previous balloon aortic valvuloplasty or cardiac surgery. The prevalence of ischaemic heart disease, diabetes mellitus, congestive cardiac failure and cerebrovascular disease were 63%, 89%, 32% and 16%, respectively. The median length of stay was 8 days[IQR4-15]. An intensive care admission was required in 14(74%) patients with a median stay of 45 hours[IQR27-51]. Thirty-day mortality was 5.3%. There were no periprocedural myocardial infarctions, a single patient had a stroke. Seven patients (36.8%) required blood transfusions and 2 patients(11%) required a permanent pacemaker within 30-days. The 1-year mortality was 21.1%(n=4).
Conclusions:
TAVR was an uncommon but increasingly utilised procedure in patients receiving chronic dialysis and was associated with reasonable outcomes. Data linkage provides an efficient way of assessing utilisation of surgeries and outcomes in this population.
Biography:
Dr Isabel Scalia is a basic physician trainee in her final year of training at the Royal Brisbane and Women’s Hospital. She intends to apply for Nephrology Advanced Training, with a passion for research and progressing clinical and medical education.