TAVR and Dialysis Are a Challenging Combination. A Case Report and Systematic Review of Literature

Advanced chronic kidney disease (CKD) is associated with poor outcomes in patients undergoing surgical aortic valve replacement, while its prognostic role in transcatheter aortic valve replacement (TAVR) remains unclear. Advanced CKD was defined according to estimated glomerular filtration rate (eGFR): 15-29 mL/min/1.73 m(2) (Stage 4-CKD G5), <15 mL/min/1.73 m(2) (Stage 5-CKD G5), and CKD G5D if the patient is on hemodialysis. End-stage renal disease (ESRD) increases the risk of developing heart valve disease, mainly aortic stenosis. Nonetheless, ESRD is also known to carry a very high surgical risk, and all the main scoring systems (i.e., STS, Euroscore II) developed to assess prognosis in patients undergoing cardiac surgery take into account this risk factor. Transcatheter aortic valve replacement (TAVR) appears to be a feasible alternative to surgical valve replacement (SAVR), but the initial trials testing this approach systematically excluded patients on dialysis. Several observational studies have been recently conducted among patients with severely impaired renal function and all found a worse prognosis in both the short and long term. We present a case report in which a successful TAVR procedure was performed due to severe symptomatic aortic stenosis in a subject with severe nephropathy. The patient in chronic dialysis developed an early degeneration of aortic bioprosthesis Medtronic CoreValve, which required surgical replacement with a mechanical valve.