Effects of Chronic Kidney Disease on Transcatheter Aortic Valve Replacement Outcomes in Low-Flow Low-Gradient Aortic Stenosis

Transcatheter aortic valve replacement (TAVR) revolutionized the treatment of aortic stenosis (AS) in patients with increased surgical risk. 1 Adams DH Popma JJ Reardon MJ Yakubov SJ Coselli JS Deeb GM Gleason TG Buchbinder M Hermiller J Kleiman NS Chetcuti S Heiser J Merhi W Zorn G Tadros P Robinson N Petrossian G Hughes GC Harrison JK Conte J Maini B Mumtaz M Chenoweth S Oh JK Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014; 370: 1790-1798 Crossref PubMed Scopus (2196) Google Scholar , 2 Makkar RR Thourani VH Mack MJ Kodali SK Kapadia S Webb JG Yoon SH Trento A Svensson LG Herrmann HC Szeto WY Miller DC Satler L Cohen DJ Dewey TM Babaliaros V Williams MR Kereiakes DJ Zajarias A Greason KL Whisenant BK Hodson RW Brown DL Fearon WF Russo MJ Pibarot P Hahn RT Jaber WA Rogers E Xu K Wheeler J Alu MC Smith CR Leon MB PARTNER 2 InvestigatorsFive-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med. 2020; 382: 799-809 Crossref PubMed Scopus (450) Google Scholar , 3 Leon MB Smith CR Mack MJ Makkar RR Svensson LG Kodali SK Thourani VH Tuzcu EM Miller DC Herrmann HC Doshi D Cohen DJ Pichard AD Kapadia S Dewey T Babaliaros V Szeto WY Williams MR Kereiakes D Zajarias A Greason KL Whisenant BK Hodson RW Moses JW Trento A Brown DL Fearon WF Pibarot P Hahn RT Jaber WA Anderson WN Alu MC Webb JG PARTNER 2 InvestigatorsTranscatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016; 374: 1609-1620 Crossref PubMed Scopus (3654) Google Scholar Patients with chronic kidney disease (CKD) represent a large proportion of these patients with elevated risk, however, CKD has been associated with worse outcomes after TAVR, thus questioning the benefit of TAVR in these patients. 4 Gupta T Goel K Kolte D Khera S Villablanca PA Aronow WS Bortnick AE Slovut DP Taub CC Kizer JR Pyo RT Abbott JD Fonarow GC Rihal CS Garcia MJ Bhatt DL Association of chronic kidney disease with in-hospital outcomes of transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2017; 10: 2050-2060 Crossref PubMed Scopus (91) Google Scholar , 5 Makki N Lilly SM Advanced chronic kidney disease: relationship to outcomes post-TAVR, a meta-analysis. Clin Cardiol. 2018; 41: 1091-1096 Crossref PubMed Scopus (22) Google Scholar , 6 Marwick TH Amann K Bangalore S Cavalcante JL Charytan DM Craig JC Gill JS Hlatky MA Jardine AG Landmesser U Newby LK Herzog CA Cheung M Wheeler DC Winkelmayer WC Sarnak MJ Conference ParticipantsChronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019; 96: 836-849 Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar , 7 Codner P Levi A Gargiulo G Praz F Hayashida K Watanabe Y Mylotte D Debry N Barbanti M Lefèvre T Modine T Bosmans J Windecker S Barbash I Sinning JM Nickenig G Barsheshet A Kornowski R Impact of renal dysfunction on results of transcatheter aortic valve replacement outcomes in a large multicenter cohort. Am J Cardiol. 2016; 118: 1888-1896 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Additionally, patients with CKD often have multiple co-morbidities which makes the independent effect of CKD on outcomes less clear. Low-flow (LF), low-gradient (LG) AS is recognized as a distinct entity, representing about 30% of severe AS cases, and remains a diagnostic and therapeutic challenge. 8 Vogelgesang A Hasenfuss G Jacobshagen C Low-flow/low-gradient aortic stenosis-Still a diagnostic and therapeutic challenge. Clin Cardiol. 2017; 40: 654-659 Crossref PubMed Scopus (10) Google Scholar Therefore, we aimed to study the relation of CKD on TAVR outcomes in patients with LF LG AS.