TAVR Outcomes in ESRD Patients Remain Poor, Large Study Shows
USA: Patients with end-stage renal disease (ESRD) who undergo transcatheter aortic valve replacement (TAVR) continue to face significantly worse outcomes compared to those without kidney failure, and these risks are not reduced even when treated at high-volume centers, according to a study published in The Annals of Thoracic Surgery.
The research was conducted by Dr. Esteban Aguayo and colleagues from the Department of Surgery, David Geffen School of Medicine, UCLA, who evaluated national outcomes of TAVR among patients with ESRD. Although TAVR is widely regarded as a less invasive and safer alternative to surgical aortic valve replacement in the general population, the study highlights that patients with severe kidney disease remain at heightened risk of mortality, prolonged hospitalizations, and frequent readmissions.
Using data from the National Readmissions Database between 2016 and 2021, the investigators analyzed more than 411,000 adult patients who underwent TAVR. Of these, approximately 7.3 percent were identified as having ESRD. Patients were grouped according to their renal status, and outcomes such as in-hospital mortality, 30-day readmission, length of hospital stay, procedural complications, and hospitalization costs were assessed. The study also examined whether institutional experience, defined by procedural volume, influenced these outcomes by comparing low-volume hospitals with high-volume centers.
The findings revealed the following:
- ESRD was linked to a 79% higher likelihood of in-hospital death compared with non-ESRD patients.
- The risk of 30-day readmission was 87% greater in ESRD patients.
- ESRD patients stayed in the hospital 1.3 days longer on average.
- Hospitalization costs for ESRD patients were about $1,000 higher.
- Non-ESRD patients benefited from lower mortality and readmission risks when treated at high-volume hospitals.
- This protective effect of high-volume centers was not observed in ESRD patients.
- Patients with ESRD continued to face persistently high rates of mortality and readmissions regardless of hospital volume.
The authors emphasized that these findings highlight the importance of individualized decision-making when considering TAVR in patients with ESRD. While the procedure may offer symptom relief and an alternative to open-heart surgery, its benefits are limited by the elevated risks inherent in this population. The study suggests that optimal patient selection, thorough pre-procedural evaluation, and strategies aimed at minimizing complications are essential to improving outcomes.
Dr. Aguayo and his team concluded that ESRD patients undergoing TAVR represent a particularly vulnerable group, and that high procedural volumes alone are insufficient to overcome their adverse prognosis. The research calls for more focused efforts to refine risk stratification and develop tailored management approaches to address the challenges of performing TAVR in patients with advanced kidney disease.
Reference:
Aguayo E, Kwon OJ, Won M, Mallick S, Coaston T, Vadlakonda A, Tabibian K, Sanaiha Y, Shemin RJ, Benharash P, Impact of Transcatheter Aortic Valve Replacement Volume on Outcomes in Patients with End Stage Renal Disease, The Annals of Thoracic Surgery (2025), doi: https://doi.org/10.1016/j.athoracsur.2025.08.009.
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