Long-term outcomes of patients receiving Dialysis and undergoing Transcatheter aortic valve replacement with contemporary balloon-expandable valves

Background Long-term clinical outcomes after transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis who received dialysis remain poorly investigated. Therefore, we aimed to evaluate long-term outcomes after TAVR using a contemporary balloon-expandable valve (BEV) in patients who received dialysis compared with those who did not. Methods In this single-center study, 143 patients who received dialysis were identified among 3189 patients who underwent TAVR with a contemporary BEV between June 2015 and February 2024. After propensity score matching, long-term outcomes were compared between 139 patients who received dialysis and 139 patients who did not. Causes of death after TAVR and predictors of mortality in the dialysis group were also investigated. Results Patients who received dialysis had higher 5-year mortality (adjusted HR: 2.38; 95% CI: 1.40–4.04; P < 0.001) than those who did not. Most deaths in the dialysis group occurred within 3 years after TAVR, and over 50% of the deaths were noncardiac-related, with infection as the leading cause. No significant differences were observed between the two groups in 5-year heart failure rehospitalization (subdistribution HR [sHR]: 1.20; 95% CI: 0.56–2.54; P = 0.640), aortic valve reintervention (sHR: 2.47; 95% CI: 0.40–15.19; P = 0.330), or disabling stroke (sHR: 0.35; 95% CI: 0.07–1.70; P = 0.190). In the dialysis group, baseline moderate or severe tricuspid regurgitation was independently associated with all-cause mortality. Conclusions Patients who received dialysis had higher 5-year mortality than those who did not, with an increase in noncardiac deaths, particularly due to infection.