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Transcatheter Aortic Valve Replacement in Dialysis Patients: Survival and Complication Rates - a Single Center Experience
Session:
SESSÃO DE POSTERS 34 - TAVI 2
Speaker:
Tatiana Pereira Dos Santos
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Tatiana Pereira Dos Santos; Andreia Rita Henriques; Ana L. Silva; Mariana Rodrigues Simões; Gonçalo Terleira Batista; Elisabete Jorge; Emanuel Ferreira; Marco Costa; Rui Alves; Lino Gonçalves
Abstract
<p>Background: Transcatheter aortic valve replacement (TAVR) is one of the standard procedures for treatment of severe aortic stenosis. Patients with end-stage renal disease on dialysis are associated with higher mortality rates and adverse outcomes in surgical substitution. Regarding TAVR they are unrepresented.</p> <p>Methods: Retrospective analysis of TAVR patients (March 2020-June 2024) at a tertiary hospital. Evaluate outcomes, procedure complications in dialysis patients (HD) submitted to TAVR in comparison to non-HD patients.</p> <p>Results: Among the 903 patients subjected to TAVR, 20 patients were on hemodialysis (2.2%). The group was composed of 70% of men with a median age of 77.5 (71-84) years. The median follow-up time was 274 (IQR 207) days. The EuroScore II had a mean of 5.12 ± 3.8%. Among cardiovascular risk factors, 55% had diabetes, 90% dyslipidemia, 95% hypertension, 15% were smokers. Also 10% had a previous myocardial infarction (MI), and 30% a previous heart failure hospitalization. All used transfemoral access with 55% balloon-expandable valves. HD patients had a higher risk (OR 3.7, 95% CI 1.3-10.6, p=0.022) of procedure and access complications. There were 5 vascular complications on HD patients: 2 immediate occlusions of the right common femoral artery and 1 perforation, promptly resolved; 2 pseudoaneurysms, 1 requiring surgery. No episodes of stroke or MI occurred. There was no statistical difference in major adverse cardiovascular events post-TAVR. There were 5 deaths in the HD group (1 case of sepsis and the remaining unknown). At 12 months the HD group versus non-HD patients presented a survival of 80%vs.94% and at 24 months 75%vs.91%, respectively. Importantly, HD patients had a 2.2 higher risk of all-cause mortality (HR 2.2, 95% CI 1.4-3.5, p=0.001), even after controlling for potential confounders (age, coronary artery disease, heart failure, CV risk factors). At the time of follow-up, 1 patient was hospitalized for TAVR structural deterioration 1 year after implantation and is currently being studied for a valve-in-valve procedure.</p> <p>Conclusion: TAVR in dialysis patients appears to be associated with a higher risk of procedure-related complications and all-cause mortality. Evaluation of valve durability was limited due to low survival and short follow-up. A better representation of this subgroup is needed.</p>
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