Trends in Readmission and Costs After Transcatheter Implantation Versus Surgical Aortic Valve Replacement in Patients With Renal Dysfunction.

Sanaiha Y, Mantha A, Ziaeian B, Juo YY, Shemin RJ, Benharash P. Trends in Readmission and Costs After Transcatheter Implantation Versus Surgical Aortic Valve Replacement in Patients With Renal Dysfunction. The American journal of cardiology. 2019 May 1; 123(9):1481-1488.

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Abstract:

Patients with renal dysfunction are at increased risk for developing aortic valve pathology. In the present era of value-based healthcare delivery, a comparison of transcatheter and surgical aortic valve replacement (SAVR) readmission performance in this population is warranted. All adult patients who underwent transcatheter or SAVR from 2011 to 2014 were identified using the Nationwide Readmissions Database, containing data for nearly 50% of US hospitalizations. Patients were further stratified as chronic kidney disease stage 1 to 5 as well as end-stage renal disease requiring dialysis. Kaplan-Meier, Cox Hazard, and multivariable regression models were generated to identify predictors of readmission and costs. Of the 350,609 isolated aortic valve replacements, 4.7% of patients suffered from chronic kidney disease stages 1 to 5 or end-stage renal disease. Transcatheter aortic valve patients with chronic kidney disease stages 1 to 5/or end-stage renal disease were older (81.9 vs 72.9 years, p < 0.0001) with a higher prevalence of heart failure (15.2 vs 4.3%, p = 0.04), and peripheral vascular disease (31.1 vs 22.8%, p < 0.0001) compared to their SAVR counterparts. Transcatheter aortic valve replacement in chronic kidney disease stage 1 to 3 patients had a higher rate of readmission due to heart failure and pacemaker placement than SAVR. Transcatheter aortic valve replacement was associated with increased costs compared with SAVR for all renal failure patients. In conclusion, in this national cohort of chronic and end-stage renal disease patients, transcatheter aortic valve implantation was associated with increased mortality, readmissions for chronic kidney disease stages1 to 3, and index hospitalization costs.