Outcomes of transcatheter aortic valve replacement in end stage liver and renal disease

Objectives This study evaluates in-hospital, 30-day, and 1-year outcomes post-transcatheter aortic valve replacement (TAVR) in end stage liver disease (ESLD) and/or end stage renal disease (ESRD) compared with patients without these comorbidities. Background TAVR is an alternative to surgical aortic valve replacement in patients with ESLD and ESRD, though current outcomes data are limited. Methods We compared 309 patients (N = 29 ESLD and/or ESRD, N = 280 control) age > 18 who underwent transfemoral TAVR from 2014 to 2020 have been compared. Results Patients with ESLD and ESRD were younger (69.9 +/- 11.7 vs. 79.1 +/- 9.8, p < .01) with higher STS-PROM scores (8.1 +/- 6.7 vs. 4.6 +/- 3.9, p < .01). ESRD and ESLD patients had similar rates of in-hospital major vascular complications (3.4% vs. 3.2%, p = .96), major bleeding events (3.4% vs. 3.2%, p = .95), and mortality (0.0% vs. 1.8%, p = .47). Mortality rates were similar at 30-days (3.4% vs. 2.1%, p = .65) with trend to higher mortality at 6-months (6.9% vs. 3.2%, p = .31) and 1-year (15.4% vs. 7.0%, p = .13). Readmission rates were higher in the ESLD and ESRD cohort at 6-months (53.2% vs. 28.6%, p < .01) and 1-year (65.4% vs. 41.0%, p = .02). One patient received dual kidney-liver transplant, 1 patient received a liver transplant, and 7 additional patients were listed for transplant. Conclusion Patients with ESLD and/or ESRD who underwent TAVR had similar mortality at discharge and 30-days compared with patients without these comorbidities with a trend toward increased mortality at 1-year. This study suggests that TAVR is an option for aortic valve disease patients with ESRD and/or ESLD in order to remove cardiac barriers to liver or kidney transplant.

Automated summary

This study compared in-hospital, 30-day, and 1-year outcomes post-TAVR in end stage liver disease and/or end stage renal disease patients with those without these comorbidities. The results showed that patients with ESLD and/or ESRD had similar mortality rates at discharge and 30-days compared to patients without these comorbidities, but with a trend towards increased mortality at 1-year, along with higher readmission rates.