Morbidity and mortality outcomes of surgical versus transcatheter aortic valve replacement in patients dependent on dialysis.

Abstract

To compare morbidity and mortality outcomes of isolated surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) among patients on dialysis over 5 years. Patients with chronic kidney disease on dialysis undergoing isolated SAVR or TAVR between 2005 and 2025 were identified from the TriNetX Research Network. Cohorts were matched on demographics and relevant comorbidities. Baseline characteristics were compared using χ² and Wilcoxon rank-sum tests for categorical and continuous variables, respectively. Early outcomes were analyzed using logistic regression. Long-term outcomes at 1, 3, and 5 years were assessed using Kaplan-Meier survival analysis and Cox proportional hazards regression. After matching, 224 patients were included in each group with adequate balance. At 1 month, pooled 3-point major adverse cardiovascular and cerebrovascular events (mortality, ischemic stroke, and acute myocardial infarction) were significantly greater in the SAVR cohort (hazard ratio [HR], 1.96; 95% CI, 1.18-2.47). Mortality did not significantly differ between cohorts at 1 year; however, it was significantly lower at 3 (HR, 0.70; 95% CI, 0.52-0.95) and 5 years (HR, 0.71; 95% CI, 0.54-0.94) with SAVR. Risk of atrial fibrillation was greater with SAVR at 1 month (odds ratio, 1.64; 95% CI, 1.09-2.47). Other cardiovascular comorbidities were similar between the cohorts over the follow-up duration. In patients who are dependent on dialysis, SAVR is associated with greater early major adverse cardiovascular and cerebrovascular events but improved long-term survival compared with TAVR.