Ethan C. Korngold MD , Ruyun Jin MD , Kateri J. Spinelli PhD , Vishesh Kumar MD , Brydan Curtis DO , Sameer Gafoor MD , Derek Phan MD , Daniel Spoon MD , Aidan Raney MD , Lisa McCabe ARNP , Brandon Jones MD
{"title":"Transcatheter Aortic Valve Replacement Outcomes in End-Stage Renal Disease Patients on Hemodialysis Requiring Midodrine","authors":"Ethan C. Korngold MD , Ruyun Jin MD , Kateri J. Spinelli PhD , Vishesh Kumar MD , Brydan Curtis DO , Sameer Gafoor MD , Derek Phan MD , Daniel Spoon MD , Aidan Raney MD , Lisa McCabe ARNP , Brandon Jones MD","doi":"10.1016/j.shj.2023.100163","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Patients with dialysis-dependent end-stage renal disease (ESRD) taking midodrine may be at high risk for poor outcomes following transcatheter aortic valve replacement (TAVR). We evaluated dialysis-dependent ESRD patients taking midodrine.</p></div><div><h3>Methods</h3><p>We conducted a retrospective analysis of non-clinical trial TAVR patients from February 2012 to December 2020 from 11 facilities in a Western US health system. Patient groups included ESRD patients on midodrine before TAVR (ESRD [+M]), ESRD patients without midodrine (ESRD [−M]), and non-ESRD patients. The endpoints of 30-day and 1-year mortality were represented by Kaplan–Meier survival estimator and compared by log-rank test.</p></div><div><h3>Results</h3><p>Forty-five ESRD (+M), 216 ESRD (−M), and 6898 non-ESRD patients were included. ESRD patients had more comorbid conditions, despite no significant difference in predicted Society of Thoracic Surgeons mortality risk between ESRD (+M) and ESRD (−M) (8.7% vs. 9.2%, <em>p</em> = 0.491). Thirty-day mortality was significantly higher for ESRD (+M) patients vs. ESRD (−M) patients (20.1% vs. 5.6%, <em>p</em> = 0.001) and for ESRD (+M) vs. non-ESRD patients (2.5%, <em>p</em> < 0.001). One-year mortality trended higher for ESRD (+M) vs. ESRD (−M) patients (41.9% vs. 29.8%, <em>p</em> = 0.07), and was significantly higher for ESRD (+M) vs. non-ESRD patients (10.7%, <em>p</em> < 0.001). Compared to ESRD (−M), ESRD (+M) patients had a higher incidence of 30-day stroke (6.7% vs. 1.4%, <em>p</em> = 0.033), 30-day vascular complications (6.7% vs. 0.9%, <em>p</em> = 0.011), and a lower rate of discharge to home (62.2% vs. 84.7%, <em>p</em> < 0.001). In contrast, ESRD (−M) patients had no significant differences from non-ESRD patients for these outcomes.</p></div><div><h3>Conclusions</h3><p>Our experience suggests ESRD patients on midodrine are a higher acuity population with worse survival after TAVR, compared to ESRD patients not on midodrine. These findings may help with risk stratification for ESRD patients undergoing TAVR.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"7 3","pages":"Article 100163"},"PeriodicalIF":1.4000,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236793/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Structural Heart","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2474870623000106","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Patients with dialysis-dependent end-stage renal disease (ESRD) taking midodrine may be at high risk for poor outcomes following transcatheter aortic valve replacement (TAVR). We evaluated dialysis-dependent ESRD patients taking midodrine.
Methods
We conducted a retrospective analysis of non-clinical trial TAVR patients from February 2012 to December 2020 from 11 facilities in a Western US health system. Patient groups included ESRD patients on midodrine before TAVR (ESRD [+M]), ESRD patients without midodrine (ESRD [−M]), and non-ESRD patients. The endpoints of 30-day and 1-year mortality were represented by Kaplan–Meier survival estimator and compared by log-rank test.
Results
Forty-five ESRD (+M), 216 ESRD (−M), and 6898 non-ESRD patients were included. ESRD patients had more comorbid conditions, despite no significant difference in predicted Society of Thoracic Surgeons mortality risk between ESRD (+M) and ESRD (−M) (8.7% vs. 9.2%, p = 0.491). Thirty-day mortality was significantly higher for ESRD (+M) patients vs. ESRD (−M) patients (20.1% vs. 5.6%, p = 0.001) and for ESRD (+M) vs. non-ESRD patients (2.5%, p < 0.001). One-year mortality trended higher for ESRD (+M) vs. ESRD (−M) patients (41.9% vs. 29.8%, p = 0.07), and was significantly higher for ESRD (+M) vs. non-ESRD patients (10.7%, p < 0.001). Compared to ESRD (−M), ESRD (+M) patients had a higher incidence of 30-day stroke (6.7% vs. 1.4%, p = 0.033), 30-day vascular complications (6.7% vs. 0.9%, p = 0.011), and a lower rate of discharge to home (62.2% vs. 84.7%, p < 0.001). In contrast, ESRD (−M) patients had no significant differences from non-ESRD patients for these outcomes.
Conclusions
Our experience suggests ESRD patients on midodrine are a higher acuity population with worse survival after TAVR, compared to ESRD patients not on midodrine. These findings may help with risk stratification for ESRD patients undergoing TAVR.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
