Transcatheter Aortic Valve Replacement Outcomes in End-Stage Renal Disease Patients on Hemodialysis Requiring Midodrine.

Ethan C Korngold, Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon, USA
Ruyun Jin, Center for Cardiovascular Analytics, Research, and Data Science (CARDS); Providence St Joseph Heart Institute, Portland, OR
Kateri Spinelli, Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon, USA
V Kumar, Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon, USA
Brydan Curtis, Providence Spokane Heart Institute, Spokane, Washington, USA
Sameer Gafoor, Swedish Heart and Vascular, Seattle, WA, USA.
Derek Phan, Swedish Heart & Vascular Institute, Cherry Hill Campus, Seattle, Washington, USA
Daniel Spoon, Providence International Heart Institute of Montana, Missoula, Montana, USA
Aidan Raney, Providence St. Joseph Hospital-Orange, Orange, California, USA
Lisa McCabe, Providence Regional Medical Center Everett, Everett, Washington, USA
Brandon Jones, Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon, USA

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%,

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.