Trimethylamine-N-Oxide and Heart Failure

(31.3%), 26 mm (37.5%), and 29 mm (31.3%) for the balloon-expanding valves. Two self-expanding valves were implanted in 1 patient (2.3%). The mean sheath size was 18.8 2.1-F. After the procedure, the mean aortic valve gradient was reduced from 46.8 13.0 mm Hg at baseline to 9.3 4.0 mm Hg (D37.4 12.3 mm Hg; p < 0.001 for paired echocardiograms), whereas moderate/severe paravalvular regurgitation and new permanent pacemaker implantation were observed in 12.2% and 20.5% of the patients, respectively. The median length of intensive care unit and hospital stays was relatively short (2.0 [IQR: 1.0 to 4.0] days and 6.0 [IQR: 5.0 to 8.0] days, respectively). In-hospital and 30-day mortality was 4.5% and 9.1%, respectively. The median follow-up was 503 days (IQR: 155 to 808 days), and no patient was lost to follow-up. Oneyear mortality was 34.1%. One-year rates of major adverse cardiac and cerebrovascular event and rehospitalization were 36.4% and 47.7%, respectively. To our knowledge, this is the largest multicenter report on the results of early and mid-term outcome of TAVR in chronic dialysis patients. The 30-day mortality of 9.1% in our study is comparable with the 30-day mortality of 7.6% and 9.7% in the overall population in the Transcatheter Valve Therapy Registries (Sapien THV), as well as in the FRANCE-2 registry (both Sapien and CoreValve THV), respectively (4,5); therefore, considering the severe comorbidity and frailty of our patients, our results further support performing TAVR in this complex setting. In addition, shorter intensive care unit and hospital stays would be a great advantage for these high-risk and frail patients. Highly calcified aorta (i.e., porcelain aorta) and iliofemoral vessels are major concerns in patients with chronic dialysis. In this study, however, neither stroke nor major vascular complications (i.e., need of surgical or endovascular intervention) occurred in the TAVR group. Conversely, 1-year mortality in our study was higher than that in the FRANCE-2 registry (34.1% vs. 24%), demonstrating the high cardiovascular risk profile in this subgroup. While a large sample size was initially included, the relatively limited number of dialysis patients precluded definitive conclusions. Our initial findings, as well as the most appropriate therapy (i.e., TAVR or SAVR) for severe AS patients with dialysis warrant future investigation. In conclusion, our preliminary experience utilizing data from a large multicenter registry suggests in a mid-term follow-up, favorable safety, and efficacy of TAVR in patients with severe AS and chronic dialysis. Yohei Ohno, MD Guilherme F. Attizzani, MD *Marco Barbanti, MD Paola D’Errigo, MD Claudio Grossi, MD Remo Daniel Covello, MD Francesco Onorati, MD Francesco Santini, MD Marco Ranucci, MD Stefano Rosato, MD Gennaro Santoro, MD Danilo Fusco, MD Corrado Tamburino, MD, PhD Fulvia Seccareccia, MD on behalf of the OBSERVANT Research Group *Department of Cardiology Ferrarotto Hospital, University of Catania Via Citelli 29 Catania 95124 Italy E-mail: mbarbanti83@gmail.com