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

Background: 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.

Methods: The 2016-2021 National Readmissions Database was queried to identify all TAVR admissions (≥18years). Patients were stratified into ESRD and nonESRD cohorts. Primary outcomes included in-hospital mortality and 30-day readmissions, while perioperative complications, length of stay (LOS), and hospitalization costs were secondarily assessed. Multivariable logistic regression and Nelson-Aalen cumulative hazard analysis were employed to evaluate factors associated with mortality and readmissions, stratified by institutional TAVR volume. Low-volume (LVH) and high-volume hospitals (HVH) were defined by quartiles of annual procedural volume.

Results: Among 411,311 patients undergoing TAVR, 7.3% had ESRD. Following risk adjustment, ESRD remained associated with higher mortality (AOR 1.79, 95%CI 1.59-2.00) and readmissions (AOR 1.87, 95%CI 1.78-1.96). Additionally, ESRD was linked to increased LOS (β+1.3days, 95%CI 1.1-1.5) and costs (β+$1.0K, 95%CI 0.5K-1.5K). After accounting for TAVR volume, nonESRD was associated with a lower risk of mortality and readmission at HVH compared to LVH, whereas ESRD was associated with similar risks regardless of institutional volume.

Conclusions: Patients with ESRD are at increased risk for postoperative mortality, hospital resource utilization, 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 is crucial for ESRD patients undergoing TAVR.