FIVE-YEAR REAL-WORLD EUROPEAN RESULTS WITH A NOVEL AORTIC BIOPROSHESIS IN PATIENTS WITH OR WITHOUT CHRONIC KIDNEY DYSFUNCTION

Background and Aim: The durability of bioprostheses in patients with advanced stage of chronic kidney disease (CKD) is not well established. Early bioprosthetic degeneration in these patients is strictly linked to secondary hyperparathyroidism with dystrophic calcification, which is demonstrated to start since CKD stage 3. The INSPIRIS Resilia (IR) valve was designed to improve durability through innovative tissue preservation technology, but in patients with CKD has not been evaluated yet. This study reports 5-year clinical outcomes and bioprosthetic performance (focusing on SVD staged according to VARC-3) in young patients with CKD undergoing SAVR in a multicenter real-world Registry. Methods: From 2017 to 2023, clinical and echocardiographic data of patients receiving IR prostheses for isolated or combined AVR were prospectively collected at 7 European Cardiac Centers. 498 patients were included: 421 with CKD stage 1 or 2, 68 with CKD stage 3 or 4, and 9 on dialysis. Results: Patients with CKD ≥3 had multiple comorbidities, higher incidence of preoperative endocarditis and more frequent reoperation after previous AVR. They exhibit a significantly higher 5-year all-cause mortality (p=0.003) and tend to have higher cardiovascular mortality (p=0.056). In a real-world setting, IR valve shows stable haemodynamics with no signs of progression of intra-prosthetic regurgitation up to 5-year follow up. Outcomes were comparable between CKD groups, with non statistical differences in terms of SVD 2 and 3, prosthetic valve endocarditis throughout the follow up. Conclusions: In young patients undergoing SAVR with an advanced stage CKD, IR showed good outcomes over a five-year follow-up period.