Early Outcomes in Japanese Dialysis Patients Treated With Transcatheter Aortic Valve Implantation

• Published in: Circulation Journal Vol. 79; no. 12; pp. 2713 - 2719
• Main Authors: Maeda, Koichi, Kuratani, Toru, Torikai, Kei, Ichibori, Yasuhiro, Nakatani, Kazuhiro, Onishi, Toshinari, Nakatani, Satoshi, Sakata, Yasushi, Ueno, Takayoshi, Toda, Koichi, Sawa, Yoshiki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2015
• Subjects: Aged; Aged, 80 and over; Aortic valve stenosis; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - therapy; Asian Continental Ancestry Group; Dialysis; Female; Follow-Up Studies; Humans; Japan; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Renal Dialysis; Transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement; Japan
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-15-0829

Background:Although transcatheter aortic valve implantation (TAVI) is a new alternative treatment with acceptable midterm results for high surgical risk patients, at present performing the procedure in dialysis patients is not reimbursed in Japan.Methods and Results:The study group of 17 dialysis patients (mean age, 76.7±5.0 years) underwent TAVI with the SAPIEN/SAPIEN XT. EuroSCORE and STS score were 25.0±19.0% and 15.4±12.3%, respectively. Transiliofemoral and transapical approaches were performed in 7 (41.2%) and 10 patients (58.8%), respectively. ICU and hospital stays after TAVI were 1.8±1.6 and 12.9±12.7 days, respectively. Mean transvalvular gradients at discharge significantly decreased from 45.9±13.3 mmHg to 10.7±4.3 mmHg (P<0.0001) and effective orifice area significantly increased from 0.78±0.17 to 1.69±0.37 cm2(P<0.0001). Device success was 87.5%. One patient required a valve-in-valve procedure on 187-postoperative-day for an acute increase in paravalvular leakage caused by initial lower implantation of the device. The overall mortality at 1 year was 0% and clinical efficacies at 30 days, 6 months, and 1 year were 93.8%, 83.3%, and 69.2%, respectively.Conclusions:Satisfactory early results were achieved with TAVI in Japanese dialysis patients with a high surgical risk, indicating it is a safe and effective alternative for the treatment of aortic valve stenosis in such patients. (Circ J 2015; 79: 2713–2719)