Circulation journal : official journal of the Japanese Circulation Society · 2025
Outcomes of Hemodialysis Patients Undergoing Contemporary Transcatheter Aortic Valve Implantation - Insights From the LAPLACE-TAVI Registry.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Higuchi Ryosuke, Narui Shuro, Takamisawa Itaru, Nanasato Mamoru, Doi Shinichiro, Okazaki Shinya, Tamura Harutoshi, Ishiyama Masaki, Yokoyama Hiroaki, Fukutomi Motoki, Takanashi Shuichiro, Saji Mike, Isobe Mitsuaki
Аннотация
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in hemodialysis patients; however, contemporary outcomes and risk stratifications remain unreported.
METHODS AND RESULTS: Using data from a multicenter database, this study included 2,888 patients who underwent TAVI between 2021 and 2024: 336 (11.6%) on hemodialysis and 2,552 (88.4%) not. The primary outcome was all-cause death after TAVI; the median follow-up was 527 days. Hemodialysis patients were younger, predominantly male, and had more comorbidities with higher surgical risk. Hemodialysis and non-hemodialysis patients had similar 30-day mortality (2.9% vs. 1.5%, respectively) and major procedural complications. Hemodialysis patients had 2- to 3-fold higher rates of all-cause death (14.4% vs. 6.5% at 1-year; 21.5% vs. 11.0% at 2 years), cardiovascular death, and the composite of all-cause death and heart failure hospitalization. After adjusting for confounders, hemodialysis had no significant effect on all-cause death and the composite endpoint. Body mass index, Clinical Frailty Scale, and albumin levels were associated with all-cause death in hemodialysis patients, allowing risk stratification into low-, intermediate-, and high-risk groups.
CONCLUSIONS: In this study, hemodialysis patients were younger and had more comorbidities, but 30-day mortality and complications were similar to the non-hemodialysis group. Although hemodialysis patients had higher all-cause mortality, the worse outcomes in this group were attributed to comorbidities rather than the hemodialysis itself.
METHODS AND RESULTS: Using data from a multicenter database, this study included 2,888 patients who underwent TAVI between 2021 and 2024: 336 (11.6%) on hemodialysis and 2,552 (88.4%) not. The primary outcome was all-cause death after TAVI; the median follow-up was 527 days. Hemodialysis patients were younger, predominantly male, and had more comorbidities with higher surgical risk. Hemodialysis and non-hemodialysis patients had similar 30-day mortality (2.9% vs. 1.5%, respectively) and major procedural complications. Hemodialysis patients had 2- to 3-fold higher rates of all-cause death (14.4% vs. 6.5% at 1-year; 21.5% vs. 11.0% at 2 years), cardiovascular death, and the composite of all-cause death and heart failure hospitalization. After adjusting for confounders, hemodialysis had no significant effect on all-cause death and the composite endpoint. Body mass index, Clinical Frailty Scale, and albumin levels were associated with all-cause death in hemodialysis patients, allowing risk stratification into low-, intermediate-, and high-risk groups.
CONCLUSIONS: In this study, hemodialysis patients were younger and had more comorbidities, but 30-day mortality and complications were similar to the non-hemodialysis group. Although hemodialysis patients had higher all-cause mortality, the worse outcomes in this group were attributed to comorbidities rather than the hemodialysis itself.