Comparison of therapeutic strategies for aortic stenosis between transcatheter and surgical aortic valve implantation: a retrospective cohort study in Japanese dialysis patients

Renal Replacement Therapy

Research

Hiroyuki Watanabe¹  Kotaro Obunai¹  Joji Ito²  Koichi Hayashi³  Yasuhiro Suzuki⁴  Michi Kobayashi⁵  Masahiro Sakai⁵  Akihiro Miyake⁵  Keisuke Takano⁵  Keita Endo⁵  Shinsuke Ito⁵  Tatsuya Ikeda⁵  Toshihiko Suzuki⁵  Kaede Yoshino⁵  Yuki Hara⁵  Koichi Kitamura⁵  Taro Hirai⁵ 

[1] Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan;Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan;Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan;Department of Medical Engineering, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan;Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, 279-0001, Urayasu, Chiba, Japan;

关键词: Hemodialysis;    Transcatheter aortic valve implantation;    Surgical aortic valve replacement;    Intradialytic hypotension;    Dialysis prescription;    Hospitalization;   

DOI  :  10.1186/s41100-023-00501-3

 received in 2023-04-30, accepted in 2023-09-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAlthough transcatheter aortic valve implantation (TAVI) is assumed to be a less invasive therapy in high-risk patients with aortic valve stenosis (AS), there have been limited data suggesting its beneficial effects on cardiovascular mortality in Japanese patients receiving dialysis therapy.MethodsHemodialysis patients with severe AS underwent either TAVI (n = 33) or surgical aortic valve replacement (SAVR, n = 25). We compared the postoperative outcomes and perioperative complications, including dialysis-associated parameters [e.g., intradialytic hypotension (IDH)], between TAVI and SAVR.ResultsA 30-day and 1-year mortality rate was nearly the same among the TAVI and the SAVR group. Incidence of permanent pacemaker implantation or other events, including stroke, bleeding and vascular complications, in the TAVI group were not different from those in SAVR patients during the 30-day or 1-year postoperative period. The incidence of IDH was increased following SAVR (odds ratio (OR) = 11.29 [95% CI 1.29–98.89]) but was not affected by TAVI (OR = 1.55 [95% CI 0.24–9.94]). Among the patients aged 75 or older, the incidence of IDH was particularly conspicuous in the SAVR group (OR = 15.75 [95% CI 2.30–107.93]). Because there were differences in background data (age, EuroSCORE II, and dialysis duration) between these groups, propensity score-matched analysis was conducted and showed no difference in the composite event-free probability between the TAVI and the SAVR group over one year (p = 0.816).ConclusionsTAVI offers an alternative strategy to Japanese hemodialysis patients with severe AS, with nearly the same incidence of complications as SAVR during 1-year observation.

【 授权许可】

CC BY   
© The Japanese Society for Dialysis Therapy and BioMed Central Ltd. 2023

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Fig. 1