TRANSCATHETER AORTIC VALVE IMPLANTATION OUTCOMES IN PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE – A RETROSPECTIVE REVIEW OF A SINGLE AUSTRALIAN CENTRE’S EXPERIENCE.
Amy Barnett1, Rosemary Masterson1,2, Kathleen Nicholls1,2 1Department of Nephrology, Royal Melbourne Hospital, Melbourne, VIC, Australia2The University of Melbourne, Melbourne, VIC, Australia
Abstract
Aim
This study aimed to describe the outcomes of patients with advanced chronic kidney disease (CKD) undergoing transcatheter aortic valve implantation (TAVI) in our single tertiary centre.
Background:
The introduction of TAVI has changed the treatment landscape of aortic valve disease significantly. However, patients with the most advanced CKD were excluded from the landmark trials and, as a result, the best treatment approach in this group remains unclear.
Methods
A single centre retrospective study of all patients undergoing TAVI between August, 2020 and April, 2022 was performed. The primary outcome was all-cause 12-month mortality. Secondary outcomes included 30-day mortality, length of stay and multiple other safety outcomes, including acute kidney injury (AKI) and need for renal replacement therapy (RRT).
Results
Of the 120 patients included in the study, 39 (32.5%) had advanced CKD (eGFR <45ml/min). There was no difference in 12-month mortality between those with advanced CKD and those without (10.3% vs. 6.2%, p= 0.47). AKI was significantly more common in the advanced CKD group (35.3% vs. 14.1%, p = 0.02). However, no patients in either group progressed to requiring any form of RRT within the twelve months following the procedure. There was no difference in any of the other measured secondary safety outcomes.
Conclusion
Patients with advanced CKD undergoing TAVI experienced significantly higher rates of post-procedural AKI. However, no patients in this study required any new RRT in the 12 months following the procedure. In this small cohort, there was no difference in 12- month mortality among patients with advanced CKD compared to those without. Further large scale, prospective studies are warranted to validate these findings and identify subgroups more likely to benefit.