Rapid Deterioration of TAVR Heart Valves Seen in Some Kidney Disease Patients: Study
A new study highlights a potential risk from TAVR (transcatheter aortic valve replacement) surgery for individuals suffering from kidney disease, indicating that some of these patients may experience rapid deterioration of their heart valves.
More than one-quarter of patients with end-stage renal disease suffered rapid deterioration of TAVR heart valves, according to findings presented at the Society for Cardiovascular Angiography and Interventions annual meeting. Research presented at a conference is considered preliminary until published in a peer-reviewed journal.
TAVR is a type of heart surgery that allows the surgeon to replace the heart valve by threading it through an artery in the leg instead of via open chest surgery. It places the valve over the damaged aortic valve in a less invasive procedure, which is why it is often favored by doctors, but can carry its own risks.
End-stage renal disease, or kidney failure, is the gradual loss of kidney function. The kidneys stop filtering waste and excess fluid from the blood, requiring dialysis for treatment.
TAVR Valve Deterioration Risks
Researchers conducted a single-center study including 95 consecutive end-stage renal disease patients who had TAVR for aortic stenosis at the Henry Ford Hospital in Detroit, Michigan, from 2012 to the present. Cases of infective endocarditis, valve thrombosis, and patient-prosthesis mismatch were excluded.
Of the kidney failure patients, 10 suffered valve events within six months of having a TAVR placement. Those patients suffered structural valve degeneration; a breakdown of the structure of the heart valve.
Kidney disease patients experienced rapid deterioration of the transcatheter aortic valve, but the data indicated the need for reintervention or repeat TAVR surgery wasn’t common, despite the deterioration. Roughly 3% of patients had reintervention compared to rates of intervention after SAVR surgical replacement, another type of valve replacement, at 2% to 7%.
The rate of valve degeneration increased steadily over the follow-up period after TAVR surgery, the researchers found. Valve degeneration occurred within one year on average, but most often occurred within two years. In 12% of cases, valve degeneration occurred by aortic stenosis and in 16% of cases by aortic regurgitation.
Overall, rates of side effects, cardiac events, and long-term major adverse events were high among patients.
TAVR Health Concerns
Other research indicates even low-risk patients who undergo TAVR surgery face an increased risk of death due to inflammation in the heart’s inner lining. Inflammation is a risk posed to all TAVR patients, whether low or high risk and may be a risk factor for valve degeneration as well.
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Despite the high risk of valve degeneration, these patients already face a risk of suffering complications, like valve disease, and death, which may be part of what contributes to the increased risk of valve degeneration, the researchers warn.
Another study published in 2021 concluded patients who undergo an emergency second TAVR surgery face an increased risk of severe bleeding events, strokes, and death. Patients who need TAVR face a significant risk of suffering other side effects.
Many patients with high-risk factors may be too high risk to undergo valve reintervention surgery to repair the valve, allowing the degeneration to progress, the researchers concluded, indicating it is important to determine which patients may be too sick to treat and who can undergo reintervention to help repair degeneration.
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