Hemodialysis patients undergoing TAVI had similar 30-day mortality but higher 1- and 2-year mortality (21.5% vs 11.0%), with comorbidities, not dialysis, driving mortality.
Does hemodialysis status independently increase the risk of all-cause mortality in patients undergoing contemporary TAVI?
In patients undergoing TAVI, higher long-term mortality in hemodialysis patients is driven by baseline comorbidities rather than the hemodialysis status itself, with similar 30-day procedural safety compared to non-dialysis patients.
Absolute Event Rate: 0% vs 0%
Abstract Background Transcatheter aortic valve implantation (TAVI) is a viable alternative to surgery for hemodialysis patients. Purpose This study aimed to compare outcomes of contemporary TAVI in hemodialysis versus non-dialysis patients and stratify all-cause mortality. Methods 336 hemodialysis patients (11.6%) and 2,552 non-dialysis patients (88.4%) undergoing TAVI (2021–2024) were analyzed. The primary endpoint was all-cause mortality, with a median follow-up of 527 days. Results Hemodialysis patients were younger (81 vs. 85 years), mostly male, and had more comorbidities. Thirty-day mortality (2.9% vs. 1.5%) and procedural complications were similar. However, 1- and 2- year all-cause mortality rates were significantly higher in hemodialysis patients (14.4% vs. 6.5%; 21.5% vs. 11.0%, respectively). After adjusting for confounders, the effect of hemodialysis on mortality and composite outcomes disappeared. Independent predictors of mortality in hemodialysis patients included body mass index, Clinical Frailty Scale, and albumin level, enabling risk stratification into low, intermediate, and high-risk groups. Conclusion Among 2,888 patients undergoing TAVI between 2021 and 2024, 11.6% were on hemodialysis. Hemodialysis patients were younger and had more comorbidities with high surgical risk. Thirty-day outcomes, including death and major complications, were similar. While all-cause mortality was significantly higher, comorbidities, not hemodialysis, were the reason for worse outcomes.Abstract picture
Narui et al. (Sat,) reported a other. Hemodialysis patients undergoing TAVI had similar 30-day mortality but higher 1- and 2-year mortality (21.5% vs 11.0%), with comorbidities, not dialysis, driving mortality.