Improvement of Fluid Overload after Transcatheter Aortic Valve Implantation among Patients with Severe Aortic Stenosis on Hemodialysis

Background Aortic stenosis (AS) and hemodialysis are closely associated with fluid overload, a major determinant of poor prognosis in dialysis patients. Transcatheter aortic valve implantation (TAVI) may improve fluid overload by ameliorating cardiac hemodynamics. This study evaluated the effects of TAVI on dialysis-related parameters, primarily fluid overload, in patients with AS undergoing hemodialysis. Methods This retrospective study analyzed 34 consecutive hemodialysis patients who underwent TAVI between September 2023 and August 2025. Dialysis session data from one month before and after TAVI were assessed. Measured Weight was defined as the mean pre-dialysis body weight, and Ideal Weight as the post-TAVI dry weight. The Excessive Weight Index (EWI) was calculated as [(Measured Weight − Ideal Weight) / Ideal Weight] × 100 (%). Subgroup analyses were performed according to improvement in left ventricular ejection fraction (LVEF). Results After TAVI, LVEF significantly improved (49.8 ± 16.7% to 52.0 ± 16.1%, p = 0.007), and EWI significantly decreased (6.5% to 4.2%, p < 0.001). The reduction in EWI was more evident in patients with improved LVEF (p = 0.002). CTR also significantly decreased after TAVI (p < 0.001). Changes in EWI were correlated with baseline LVEF (p = 0.019). Conclusions TAVI was associated with improved fluid status in patients with AS undergoing hemodialysis. EWI may serve as a practical surrogate marker for assessing changes in fluid overload.