Author + information
- Received March 2, 2017
- Revision received May 2, 2017
- Accepted May 4, 2017
- Published online October 16, 2017.
- Charles J. Ferro, MDa,∗ (, )
- Jonathan P. Law, MBChBa,
- Sagar N. Doshi, MDa,
- Mark de Belder, MDb,
- Neil Moat, MSc,
- Mamas Mamas, DPhild,
- David Hildick-Smith, MDe,
- Peter Ludman, MDa,
- Jonathan N. Townend, MDa,
- on behalf of the UK TAVI Steering Group and the National Institute for Cardiovascular Outcomes Research
- aBirmingham Cardio-Renal Group, Birmingham Health Partners, Queen Elizabeth Hospital, Birmingham, United Kingdom
- bDepartment of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom
- cDepartment of Cardiology, Royal Brompton and Harefield Hospitals, London, United Kingdom
- dKeele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
- eSussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
- ↵∗Address for correspondence:
Prof. Charles J. Ferro, Department of Nephrology, Queen Elizabeth Hospital, Mindehlson Way, Edgbaston, Birmingham B15 2WB, United Kingdom.
Objectives This study sought to determine the risk factors for post-transcatheter aortic valve replacement (TAVR) dialysis and to determine the impact of pre-TAVR or post-TAVR dialysis on mortality.
Background TAVR is now established as an alternative treatment to surgical aortic valve replacement. Data examining the impact of dialysis on outcomes after TAVR are lacking.
Methods The UK TAVI (Transcatheter Aortic Valve Implantation) Registry was established to report outcomes on all TAVR procedures performed within the United Kingdom (2007 to 2014). Data were collected prospectively on 6,464 patients with a median follow-up of 625 days.
Results The proportion of patients on dialysis before TAVR has remained constant at 1.8%. After TAVR, the proportion of patients newly needing dialysis after TAVR has fallen from 6.1% (2007 to 2008) to 2.3% (2013 to 2014). The risk of new dialysis requirement after TAVR was independently associated with lower baseline renal function, year of procedure, impaired left ventricular function, diabetes, use of an Edwards valve, a nontransfemoral approach, need for open surgery, and moderate-to-severe aortic regurgitation after the procedure. Requirement for new dialysis after TAVR was associated with higher mortality at 30 days (hazard ratio: 6.44; 95% confidence interval: 4.87 to 8.53) and at 4 years (hazard ratio: 3.54; 95% confidence interval: 2.99 to 4.19; p < 0.001 for all) compared with patients without dialysis requirement.
Conclusions The proportion of patients needing dialysis after TAVR has decreased over time. Post-TAVR dialysis is associated with increased mortality. Factors identified with dialysis requirement after TAVR require further investigation.
Dr. Doshi has served as a proctor for Edwards Lifesciences and Boston Scientific. Mr. Moat has served as a proctor and consultant to Medtronic. Dr. Hildick-Smith has served as a proctor and consultant for Boston Scientific, Medtronic, and Edwards Lifesciences. Dr. Townend has received educational support and training from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 2, 2017.
- Revision received May 2, 2017.
- Accepted May 4, 2017.