Impact of Transcatheter Aortic Valve Replacement Volume on Outcomes in Patients With End-Stage Renal Disease.

Abstract

Patients with end-stage renal disease (ESRD) are at increased risk for calcific aortic stenosis. Given limited data on the efficacy of transcatheter aortic valve replacement (TAVR) in this population, the present study examined acute mortality, complications, and 30-day nonelective readmissions in a national cohort of patients with ESRD. The 2016 to 2021 National Readmissions Database was queried to identify all TAVR admissions (in patients aged ≥18 years). Patients were stratified into ESRD and non-ESRD cohorts. Primary outcomes included in-hospital mortality and 30-day readmissions, whereas perioperative complications, length of stay, and hospitalization costs were secondarily assessed. Multivariable logistic regression and Nelson-Aalen cumulative hazard analysis were used to evaluate factors associated with mortality and readmissions, stratified by institutional TAVR volume. Low-volume and high-volume hospitals were defined by quartiles of annual procedural volume. Among 411,311 patients undergoing TAVR, 7.3% had ESRD. After risk adjustment, ESRD remained associated with higher mortality (adjusted odds ratio, 1.79; 95% CI, 1.59-2.00) and readmissions (adjusted odds ratio, 1.87; 95% CI, 1.78-1.96). Additionally, ESRD was linked to increased length of stay (β, +1.3 days; 95% CI, 1.1-1.5) and costs (β, +$1.0K; 95% CI, 0.5K-1.5K). After accounting for TAVR volume, non-ESRD was associated with a lower risk of mortality and readmission at high-volume hospitals compared with low-volume hospitals, whereas ESRD was associated with similar risks regardless of institutional volume. Patients with ESRD are at increased risk for postoperative mortality, hospital resource use, and readmissions. This association was not mitigated at high-TAVR volume centers. Given the increased risk of mortality and readmission, careful patient selection and optimization are crucial for patients with ESRD who are undergoing TAVR.