Impact of Severity of Chronic Kidney Disease on Management and Outcomes Following Transcatheter Aortic Valve Replacement With Newer-Generation Transcatheter Valves

Background. The association between chronic kidney disease (CKD) and outcomes following transcatheter aortic valve replacement [TAVR] in the setting of newer-generation transcatheter heart valves [THVs] is not well known. Accordingly, we sought to assess the impact of CKD severity on outcomes in adults undergoing TAVR with newer-generation THVs. Methods. The study population included 298 consecutive patients who underwent TAVR with a newer-generation THV [Sapien 3 [Edwards Lifesciences] or CoreValve Evolut R or Evolut Pro [Medtronic]] from December 2015 to June 2018 at an academic tertiary medical center. Patients were classified into three groups: group I, defined as creatinine clearance [CrCl] >= 60 mL/min [n = 133]: group II, defined as CrCl >= 30 mL/min and <60 mL/min [n = 128]; and group III, defined as CrCl <30 mL/min (n = 37). Results. Median length of stay was longer in groups II and III (2.0 days in group I vs 3.0 days in group II vs 4.0 days in group III; P<.01). While rates of 30-day readmission were significantly higher in groups II and III compared with group I [14.5% in group I vs 26.6% in group II vs 37.1% in group III; P<.01], rates of in-hospital and 30-day mortality and disabling stroke were similar. In multivariable analysis, CKD was independently associated with higher 30-day readmission rates [group II: odds ratio, 2.10; 95% confidence interval 1.02-4.32; group III: odds ratio, 3.52; 95% confidence interval, 1.40-8.87; group I: referent]. Conclusions. In this prospective study of adults undergoing TAVR with newer-generation THVs, moderate and severe CKD was associated with a nearly 2-fold and 3-fold higher risk of 30-day readmission. respectively.