Impact of Renal Dysfunction on Transcatheter Aortic Valve Replacement Outcome in a Large Multicenter Cohort

Background: Patients with advanced chronic renal dysfunction were excluded from randomized Transcatheter Aortic Valve Replacement trials. The potential impact of chronic renal disease on TAVR prognosis is not fully understood.

Objectives: We sought to evaluate outcomes within a large cohort of patients undergoing TAVR distinguished by renal function.

Methods: Baseline characteristics, procedural data and follow-up findings were collected from 10 high-volume centers in Europe, Israel and Japan among TAVR treated patients with and without renal disease.

Results: Patients (n=1204) were divided into 4 groups according to pre-TAVR glomerular filtration rate (eGFR): group I (eGFR ≥60) n=288 (female 44.8%), group II (eGFR ≥30 <60) n=452 (female 61.1%), group III (eGFR <30) n=398 (female 61.1%) and group IV (on dialysis) n=66 (female 31.3%). Mean age was 78.5±7, 82.3±5, 83.8±5and 76.1±7 y/o for patients in group I, II, III and IV; respectively (p<0.001). Mean Society of Thoracic Surgeons (STS) score was higher in patients with lower pre-procedural eGFR: 5.4 (3.7-7.1) in group I, 6.0 (4.3-9) in group II, 8.8 (6.0-12.6) in group III and 10.1 (7.7-16) in group IV; (p <0.001).

Rates of all-cause mortality at 1-year follow up were higher for patients with lower pre-procedural eGFR (Figure) By multivariate analysis, every 10-mg/dL decrease in eGFR were associated with a respective 19% (p<0.001), 14% (p=0.018), 35% (p<0.001), and 16% (p=0.007) increase in the risk of death, cardiovascular death, major bleeding, and valve failure, respectively. eGFR did not affect the risk for CVA or pacemaker implantation.

Conclusions: Among patients undergoing TAVR, baseline renal dysfunction is an important independent predictor for all-cause mortality with incremental prognostic impact.