In-hospital mortality after transcatheter aortic valve implantation versus surgical aortic valve replacement in maintenance hemodialysis patients: a Japanese nationwide retrospective cohort study

Patients with maintenance dialysis are at high risk for adverse outcomes after aortic valve replacement and have been largely excluded from major trials comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Comparative evidence in this population remains limited. We aimed to compare in-hospital outcomes between TAVI and SAVR in patients undergoing maintenance hemodialysis using a nationwide Japanese database. We conducted a retrospective cohort study of maintenance hemodialysis patients who underwent TAVI or SAVR between February 2021 and March 2023 using the Japanese Diagnosis Procedure Combination database. The primary outcome was in-hospital mortality. Secondary outcomes included length of hospital stay and in-hospital aortic valve reintervention. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences. Among 1,649 patients, 966 underwent TAVI and 683 underwent SAVR. In-hospital mortality was lower in the TAVI group than in the SAVR group (3.0% vs 5.9%). After IPTW, TAVI was associated with lower in-hospital mortality (odds ratio 0.44, 95% confidence interval 0.24-0.79). Length of hospital stay was shorter in the TAVI group (median 14.0 days) than the SAVR group (29.0 days). In-hospital aortic valve reintervention was rare. In a sensitivity analysis restricted to hospitals performing both procedures, the association favored TAVI but was attenuated (OR 0.75, 95% CI 0.34-1.65). In patients receiving maintenance hemodialysis, TAVI was associated with lower in-hospital mortality and shorter hospital stay compared with SAVR.