Five-Year Transcatheter Aortic Valve Replacement Outcomes in Chronic Hemodialysis vs. Non-Hemodialysis Patients Using Balloon-Expandable Devices

• Published in: Circulation Journal p. CJ-24-0050
• Main Authors: Mizote, Isamu, Nakamura, Daisuke, Maeda, Koichi, Dohi, Tomoharu, Shimamura, Kazuo, Kawamura, Ai, Yamashita, Kizuku, Matsuhiro, Yutaka, Kosugi, Shumpei, Sugae, Hiroki, Takeda, Yasuharu, Sakata, Yasushi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 11.05.2024
• Subjects: Structural valve deterioration; Transcatheter aortic valve durability; Transcatheter aortic valve replacement; Structural valve deterioration; Transcatheter aortic valve durability; Transcatheter aortic valve replacement
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-24-0050

Background: Based on the results of a clinical trial in Japan, transcatheter aortic valve replacement (TAVR) for hemodialysis (HD) patients gained approval; however, mid-term TAVR outcomes and transcatheter aortic valve (TAV) durability in HD patients remain unexplored.Methods and Results: We analyzed background, procedural, in-hospital outcome, and follow-up data for 101 HD patients and 494 non-HD patients who underwent TAVR using balloon-expandable valves (SAPIEN XT or SAPIEN 3) retrieved from Osaka University Hospital TAVR database. Periprocedural mortality and TAVR-related complications were comparable between HD and non-HD patients. However, Kaplan-Meier analysis revealed that HD patients had significantly lower survival rates (log-rank test, P<0.001). In addition, HD patients had significantly higher rates of severe structural valve deterioration (SVD) than non-HD patients (Gray test, P=0.038).Conclusions: TAVR in HD patients had comparable periprocedural mortality but inferior mid-term survival and TAV durability than in non-HD patients. Indications for TAVR in younger HD patients should be carefully determined, considering the possibility of a TAV-in-TAV procedure when early SVD occurs.