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Pasceri V, Pelliccia F, Mehran R, Dangas G, Porto I, Radico F, Biancari F, D'Ascenzo F, Saia F, Luzi G, Bedogni F, Amat Santos IJ, De Marzo V, Dimagli A, Mäkikallio T, Stabile E, Blasco‐Turrión S, Testa L, Barbanti M, Tamburino C, Fabiocchi F, Chilmeran A, Conrotto F, Costa G, Stefanini G, Spaccarotella C, Macchione A, La Torre M, Bendandi F, Juvonen T, Wańha W, Wojakowski W, Benedetto U, Indolfi C, Hildick‐Smith D, Zimarino M. Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2024; 13:e032955. [PMID: 38533944 PMCID: PMC11179782 DOI: 10.1161/jaha.123.032955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Dialysis is a rare but serious complication after transcatheter aortic valve replacement. We analyzed the large multicenter TRITAVI (transfusion requirements in transcatheter aortic valve implantation) registry in order to develop and validate a clinical score assessing this risk. METHODS AND RESULTS A total of 10 071 consecutive patients were enrolled in 19 European centers. Patients were randomly assigned (2:1) to a derivation and validation cohort. Two scores were developed, 1 including only preprocedural variables (TRITAVIpre) and 1 also including procedural variables (TRITAVIpost). In the 6714 patients of the derivation cohort (age 82±6 years, 48% men), preprocedural factors independently associated with dialysis and included in the TRITAVIpre score were male sex, diabetes, prior coronary artery bypass graft, anemia, nonfemoral access, and creatinine clearance <30 mL/min per m2. Additional independent predictors among procedural features were volume of contrast, need for transfusion, and major vascular complications. Both scores showed a good discrimination power for identifying risk for dialysis with C-statistic 0.78 for TRITAVIpre and C-statistic 0.88 for TRITAVIpost score. Need for dialysis increased from the lowest to the highest of 3 risk score groups (from 0.3% to 3.9% for TRITAVIpre score and from 0.1% to 6.2% for TRITAVIpost score). Analysis of the 3357 patients of the validation cohort (age 82±7 years, 48% men) confirmed the good discrimination power of both scores (C-statistic 0.80 for TRITAVIpre and 0.81 for TRITAVIpost score). Need for dialysis was associated with a significant increase in 1-year mortality (from 6.9% to 54.4%; P=0.0001). CONCLUSIONS A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement.
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Affiliation(s)
| | | | | | | | - Italo Porto
- Chair of Cardiovascular Disease, Department of Internal Medicine and SpecialtiesUniversity of GenoaItaly
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCSOspedale Policlinico San MartinoGenoaItaly
| | | | - Fausto Biancari
- Department of MedicineSouth Karelia Central Hospital, University of HelsinkiLappeenrantaFinland
| | - Fabrizio D'Ascenzo
- Department of Internal MedicineCittà della Salute e della ScienzaTurinItaly
| | - Francesco Saia
- Department of Cardiothoracic Vascular SurgeryUniversity HospitalBolognaItaly
| | - Giampaolo Luzi
- Cardiovascular DepartmentAzienda Ospedaliera Regionale “San Carlo”PotenzaItaly
| | - Francesco Bedogni
- Department of CardiologyIRCCS Policlinico San Donato, San Donato MilaneseMilanItaly
| | - Ignacio J. Amat Santos
- CIBERCV, Interventional CardiologyHospital Clínico Universitario de ValladolidValladolidSpain
| | - Vincenzo De Marzo
- Chair of Cardiovascular Disease, Department of Internal Medicine and SpecialtiesUniversity of GenoaItaly
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCSOspedale Policlinico San MartinoGenoaItaly
- Department of CardiologyASL2 AbruzzoChietiItaly
| | - Arnaldo Dimagli
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew YorkNY
| | - Timo Mäkikallio
- Department of MedicineSouth Karelia Central Hospital, University of HelsinkiLappeenrantaFinland
| | - Eugenio Stabile
- Cardiovascular DepartmentAzienda Ospedaliera Regionale “San Carlo”PotenzaItaly
| | - Sara Blasco‐Turrión
- CIBERCV, Interventional CardiologyHospital Clínico Universitario de ValladolidValladolidSpain
| | - Luca Testa
- Department of CardiologyIRCCS Policlinico San Donato, San Donato MilaneseMilanItaly
| | | | - Corrado Tamburino
- Division of CardiologyA.O.U. Policlinico “G. Rodolico—San Marco”CataniaItaly
| | - Franco Fabiocchi
- Centro Cardiologico Monzino, IRCCSMilanItaly
- Galeazzi‐Sant’Ambrogio Hospital, I.R.C.C.SMilanItaly
| | - Ahmed Chilmeran
- Department of CardiologyRoyal Sussex County HospitalBrightonUK
| | - Federico Conrotto
- Department of Internal MedicineCittà della Salute e della ScienzaTurinItaly
| | - Giuliano Costa
- Division of CardiologyA.O.U. Policlinico “G. Rodolico—San Marco”CataniaItaly
| | | | | | - Andrea Macchione
- Chair of Cardiovascular Disease, Department of Internal Medicine and SpecialtiesUniversity of GenoaItaly
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCSOspedale Policlinico San MartinoGenoaItaly
| | - Michele La Torre
- Department of Internal MedicineCittà della Salute e della ScienzaTurinItaly
| | - Francesco Bendandi
- Department of Cardiothoracic Vascular SurgeryUniversity HospitalBolognaItaly
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Central HospitalUniversity of HelsinkiFinland
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | | | - Ciro Indolfi
- Division of CardiologyUniversity Magna GraeciaCatanzaroItaly
| | | | - Marco Zimarino
- Department of CardiologyASL2 AbruzzoChietiItaly
- Department of Neuroscience, Imaging and Clinical Sciences‘G. D’Annunzio’ University of Chieti‐PescaraItaly
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2
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Petersen JK, Østergaard L, Carlson N, Bager LGV, Strange JE, Schou M, Køber L, Fosbøl EL. Impact of Acute Kidney Injury After Transcatheter Aortic Valve Replacement: A Nationwide Study. J Am Heart Assoc 2024; 13:e031019. [PMID: 38156458 PMCID: PMC10863835 DOI: 10.1161/jaha.123.031019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/15/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND In patients undergoing transcatheter aortic valve replacement (TAVR), the impact of acute kidney injury (AKI) on the prognosis and especially on future kidney function has been sparsely examined, and data from large cohorts are warranted. METHODS AND RESULTS With Danish nationwide registries, we identified all patients undergoing TAVR from 2014 to 2021 with no previous dialysis treatment. According to 2 plasma creatinine samples, we identified those suffering a postprocedural AKI within 21 days after TAVR. With 1 year of follow-up, we compared the associated rates of dialysis treatment and death between patients with and without an AKI using multivariable Cox analysis. Finally, according to the lowest recorded creatinine sample, we assessed the kidney function among AKI survivors between 90 and 180 days after the index date. We identified 4091 TAVRs: 193 (4.7%) with AKI (55.4% men; median age, 82 years) and 3898 (95.3%) without AKI (57.0% men; median age, 81 years). Compared with those without AKI, patients with AKI showed increased associated 1-year rates of dialysis treatment (hazard ratio [HR], 7.20 [95% CI, 4.10-12.66]) and death (HR, 2.39 [95% CI, 1.59-3.58]). After 6 months, 74% of AKI survivors had complete kidney recovery, 14.7% had incomplete kidney recovery, 6.3% failed to recover, and 5.1% were on dialysis treatment. CONCLUSIONS We identified that AKI after TAVR was associated with an increased rate of future dialysis treatment and all-cause death. Among survivors, 74% had complete kidney recovery within 6 months.
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Affiliation(s)
- Jeppe Kofoed Petersen
- Department of CardiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Lauge Østergaard
- Department of CardiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Nicholas Carlson
- Department of NephrologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | | | - Jarl E. Strange
- Department of CardiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Morten Schou
- Department of CardiologyHerlev and Gentofte University HospitalCopenhagenDenmark
| | - Lars Køber
- Department of CardiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Emil Loldrup Fosbøl
- Department of CardiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
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3
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Wang R, Liu X, Yao J, Schoepf UJ, Griffith J, Wang J, Lian J, Jiang K, Song G, Xu L. The feasibility of relaxation-enhanced angiography without contrast and triggering for preprocedural planning of transcatheter aortic valve implantation. Front Cardiovasc Med 2023; 10:1284743. [PMID: 38179508 PMCID: PMC10766106 DOI: 10.3389/fcvm.2023.1284743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024] Open
Abstract
Background Cardiovascular MRI is advantageous in transcatheter aortic valve implantation (TAVI) planning. This study aimed to evaluate the feasibility of comprehensive non-contrast MRI [relaxation-enhanced angiography without contrast and triggering (REACT)] combined with a three-dimensional whole-heart MRI protocol for preprocedural planning of TAVI vs. computed tomography angiography (CTA). Methods Thirty patients with severe aortic stenosis were prospectively enrolled. The anatomical properties of the aortic root anatomy, including the perimeter and area of the virtual aortic valve annulus and coronary heights, were determined from 3D whole-heart MRI and cardiac CTA (CCTA) images, respectively. The diameters of the aorta (thoracic and abdominal aorta) and iliofemoral arteries were measured from REACT and aortic CTA (ACTA) images, respectively. A paired t-test was used to compare these two modalities. Bland-Altman plots were used to assess cardiovascular MRI and CTA measurements. Transcatheter heart valve (THV) sizing was performed based on CCTA measurements and compared with 3D whole-heart MRI measurements. The extent of annular calcification on 3D whole-heart MRI images was evaluated by a four-point grading scale and compared with CCTA data. Results All 30 patients completed CTA and cardiovascular MRI examinations, with the TAVI procedure being administered in 25 patients. The mean acquisition time of the comprehensive MRI protocol was 18 ± 3.2 min. There were no significant differences between ACTA and REACT data in regard to the diameters of aortic and iliofemoral arteries, including the ascending thoracic aorta (37 ± 4.6 mm vs. 37.7 ± 5.2 mm, p = 0.085), descending thoracic aorta (24.3 ± 2.8 mm vs. 24.3 ± 2.8 mm, p = 0.832), abdominal aorta (20.9 ± 2.5 mm vs. 20.8 ± 2.5 mm, p = 0.602), bilateral common iliac arteries (right: 8.36 ± 1.44 mm vs. 8.42 ± 1.27 mm, p = 0.590; left: 8.61 ± 1.71 mm vs. 8.86 ± 1.46 mm, p = 0.050), and bilateral femoral arteries (right: 6.77 ± 1.06 mm vs. 6.87 ± 1.00 mm, p = 0.157; left: 6.75 ± 1.02 mm vs. 6.90 ± 0.80 mm, p = 0.142). Both modalities showed similar aortic valve morphology and semi-quantitative valve calcification (all, p's > 0.05). Overall agreement for implanted THV was found in all 25 (100%) patients assessed with both modalities. Conclusion REACT combined with 3D whole-heart MRI enables reliable measurements of aortic root anatomy, annular calcification, and aorta and iliofemoral access in patients under evaluation for TAVI.
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Affiliation(s)
- Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinmin Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Yao
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - U. Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC, United States
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Joseph Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC, United States
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Jiayang Wang
- Center of Coronary Artery Surgery, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Ke Jiang
- Philips Healthcare, Beijing, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Obata Y, Kamijo-Ikemori A, Shimmi S, Inoue S. Clinical usefulness of urinary biomarkers for early prediction of acute kidney injury in patients undergoing transaortic valve implantation. Sci Rep 2023; 13:18569. [PMID: 37903844 PMCID: PMC10616062 DOI: 10.1038/s41598-023-46015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/26/2023] [Indexed: 11/01/2023] Open
Abstract
This study aimed to reveal the clinical usefulness of urinary biomarkers for the early prediction of AKI onset after transcatheter aortic valve implantation (TAVI) (n = 173). In this study, 22 (12.7%) patients had AKI, of which 21 had mild AKI and 1 had moderate AKI. Higher levels of urinary liver-type fatty acid binding protein (L-FABP), [tissue inhibitor of metalloproteinases-2] × [insulin-like growth factor-binding protein 7], clusterin and urinary albumin before, after and 4 h after TAVI were associated with AKI onset. However, the time point of higher urinary N-acetyl-β-D-glucosaminidase levels related to AKI onset was only before TAVI. No significant differences were found in the area under the receiver-operator characteristic curves (AUC) for predicting AKI onset between urinary biomarkers before TAVI. After TAVI, the AUC (0.81) of urinary albumin was significantly higher than those of any other urinary biomarkers. The sensitivity (0.86) in urinary albumin after TAVI and specificity (0.98) in urinary L-FABP before TAVI were the highest among urinary biomarkers. In conclusion, urinary biomarkers may be clinically useful for early differentiation of patients with a higher or lower risk for AKI onset or early prediction of post-TAVI onset of AKI.
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Affiliation(s)
- Yumi Obata
- Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Atsuko Kamijo-Ikemori
- Department of Anatomy, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Sachi Shimmi
- Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Soichiro Inoue
- Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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5
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Pampori A, Shekhar S, Kapadia SR. Implications of Renal Disease in Patients Undergoing Structural Interventions. Interv Cardiol Clin 2023; 12:539-554. [PMID: 37673498 DOI: 10.1016/j.iccl.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Percutaneous structural interventions have a major impact on the morbidity, mortality, and quality of life of patients by providing a lower-risk alternative to cardiac surgery. However, renal disease has a significant impact on outcomes of these interventions. This review explores the incidence, outcomes, pathophysiology, and preventative measures of acute kidney injury and chronic kidney disease on transcatheter aortic valve replacement, transcatheter mitral valve repair, and percutaneous balloon mitral valvuloplasty. Given the expanding indications for percutaneous structural interventions, further research is needed to identify ideal patients with chronic kidney disease or end-stage renal disease who would benefit from intervention.
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Affiliation(s)
- Adam Pampori
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA.
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6
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Singh S, Pershad A. White paper on Mitigating Risk Factors for Acute kidney injury in TAVR: A Protocol to decrease TAVR-associated AKI. Indian Heart J 2023:S0019-4832(23)00071-8. [PMID: 37084808 DOI: 10.1016/j.ihj.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/09/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023] Open
Abstract
Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) portends a poor prognosis. In the TVT registry, AKI after TAVR occurred in 10% of the patients. The etiology of AKI after TAVR is multifactorial but contrast volume remains one of the few modifiable risk factors. As patients referred for TAVR have multiple touch points within a siloed healthcare system, there remains an unmet clinical need of a well-defined clinical pathway to minimize the risk of AKI from the time of referral for TAVR to the completion of the procedure. This white paper aims to provide such a clinical pathway.
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Affiliation(s)
- Sohrab Singh
- The Brooklyn Hospital Center, Clinical and Academic Affiliate of Icahn School of Medicine at Mount Sinai
| | - Ashish Pershad
- Dignity Health Medical Group, Chandler Regional and Mercy Gilbert Medical Center.
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De Marzo V, Viglino U, Zecchino S, Matos JG, Piredda E, Pigati M, Vercellino M, Crimi G, Balbi M, Seitun S, Porto I. Supra-renal aortic atheroma extent and composition predict acute kidney injury after transcatheter aortic valve replacement: A three-dimensional computed tomography study. Int J Cardiol 2023; 381:8-15. [PMID: 37001646 DOI: 10.1016/j.ijcard.2023.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Acute kidney injury (AKI) may complicate transcatheter aortic valve replacement (TAVR) and could be linked to atheroembolization associated with catheter manipulation in the supra-renal (SR) aorta. We sought to determine the impact of SR aortic atheroma burden (SR-AAB) and composition, as well as of the aortic valve calcium score (AV-CS), measured at pre-operative multislice computed tomography (PO-MSCT), on AKI-TAVR. METHODS All TAVR-patients 3 January-2018 to December-2020 were included. A three-dimensional analysis of PO-MSCT was performed, calculating percentage SR-AAB (%SR-AAB) as [(absolute SR-AAB volume)*100/vessel volume]. Types of plaque were defined according to Hounsfield unit (HU) intensity ranges. Calcified plaque was subcategorized into 3 strata: low- (351-700 HU), mid- (701-1000 HU), and high‑calcium (>1000 HU, termed 1 K-plaque). RESULTS The study population included 222 patients [mean age 83.3 ± 5.7 years, 95 (42.8%) males], AKI-TAVR occurred in 67/222 (30.2%). Absolute SR-AAB (41.3 ± 16.4 cm3 vs. 32.5 ± 10.7 cm3,p < 0.001) and %SR-AAB (17.6 ± 5.1% vs. 13.9 ± 4.3%,p < 0.001) were significantly higher in patients developing AKI-TAVR. Patients who developed AKI-TAVR had higher mid‑calcium (6.9 ± 3.8% vs. 4.2 ± 3.5%,p < 0.001) and 1 K-plaque (5.4 ± 3.7% vs. 2.4 ± 2.4%,p < 0.001) with no difference in AV-CS (p = 0.691). Adjusted multivariable logistic regression analysis showed that %SR-AAB [OR (x%increase): 1.12, 95%CI: 1.04-1.22,p = 0.006] and %SR-calcified plaque [OR (x%increase): 5.60, 95%CI: 2.50-13.36,p < 0.001] were associated with AKI-TAVR. Finally, 3-knots spline analyses identified %SR-AAB >15.0% and %SR-calcified plaque >7.0% as optimal thresholds to predict an increased risk of AKI-TAVR. CONCLUSIONS Suprarenal aortic atheroma, when highly calcified, is associated with AKI-TAVR. Perioperative-MSCT assessment of aortic atherosclerosis may help in identification of patients at high-risk for AKI-TAVR, who could benefit from higher peri-operative surveillance.
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Affiliation(s)
- Vincenzo De Marzo
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Umberto Viglino
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Zecchino
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Joao Gavina Matos
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Piredda
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Maria Pigati
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Vercellino
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Gabriele Crimi
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Manrico Balbi
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy; Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Seitun
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy; Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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8
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Crimi G, De Marzo V, De Marco F, Conrotto F, Oreglia J, D'Ascenzo F, Testa L, Gorla R, Esposito G, Sorrentino S, Spaccarotella C, Soriano F, Bruno F, Vercellino M, Balbi M, Morici N, Indolfi C, De Ferrari GM, Bedogni F, Porto I. Acute Kidney Injury After Transcatheter Aortic Valve Replacement Mediates the Effect of Chronic Kidney Disease. J Am Heart Assoc 2022; 11:e024589. [PMID: 36172945 DOI: 10.1161/jaha.121.024589] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. However, it is controversial whether AKI affects prognosis per se, being linked to baseline chronic kidney disease (CKD) and bleeding complications. The aim of this study was to disentangle, applying mediation analysis, the association between AKI and clinical outcome, considering CKD and bleedings. Methods and Results Consecutive patients undergoing TAVR were prospectively enrolled at 5 high-volume centers in Italy. AKI was defined according to Valve Academic Research Consortium-3 consensus, whereas bleeding with Bleeding Academic Research Consortium. Primary outcome was all-cause mortality after 1-year follow-up. Among 2621 patients undergoing TAVR, AKI occurrence was associated with 1-year mortality. This association of AKI with the primary end points remained significant after adjusting for baseline risk estimators, either Society of Thoracic Surgeons score (hazard ratio [HR], 2.78 [95% CI, 1.95-3.80], P<0.001) or EuroSCORE-II (HR, 1.85 [95% CI, 1.35-2.56], P<0.001). Both AKI and CKD significantly and independently affected primary outcome (HR, 3.06 [95% CI, 2.01-4.64], P<0.001 and HR, 1.82 [95% CI 1.27-2.65], P<0.01, respectively). The estimated proportion of the total effect of CKD mediated via AKI was, on average, 15%, 95% CI, 4%-29%, P<0.001. The significant effect of Bleeding Academic Research Consortium 2-5 bleedings on the primary outcome was not mediated by AKI. Conclusions AKI occurs in 1 out of 6 patients and significantly mediates one fifth of the effect of baseline CKD on all-cause mortality after TAVR. Our analysis supports a systematic effort to prevent AKI during TAVR, which may potentially translate into improved patients' 1-year survival.
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Affiliation(s)
- Gabriele Crimi
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy
| | - Vincenzo De Marzo
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy.,Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
| | - Federico De Marco
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department University of Turin, Città della Salute e della Scienza Turin Italy
| | - Jacopo Oreglia
- Cardiology I, "A. De Gasperis" Department Ospedale Niguarda Ca' Granda Milan Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department University of Turin, Città della Salute e della Scienza Turin Italy
| | - Luca Testa
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Riccardo Gorla
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Giuseppe Esposito
- Cardiology I, "A. De Gasperis" Department Ospedale Niguarda Ca' Granda Milan Italy
| | - Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Sciences, Catanzaro Italian Society of Cardiology (SIC) Magna Graecia University Catanzaro Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, Catanzaro Italian Society of Cardiology (SIC) Magna Graecia University Catanzaro Italy
| | - Francesco Soriano
- Cardiology I, "A. De Gasperis" Department Ospedale Niguarda Ca' Granda Milan Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department University of Turin, Città della Salute e della Scienza Turin Italy
| | - Matteo Vercellino
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy
| | - Manrico Balbi
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy.,Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
| | - Nuccia Morici
- Cardiology I, "A. De Gasperis" Department Ospedale Niguarda Ca' Granda Milan Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Catanzaro Italian Society of Cardiology (SIC) Magna Graecia University Catanzaro Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department University of Turin, Città della Salute e della Scienza Turin Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy.,Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
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9
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Klug G, Reinstadler S, Troger F, Holzknecht M, Reindl M, Tiller C, Lechner I, Fink P, Pamminger M, Kremser C, Ulmer H, Bauer A, Metzler B, Mayr A. Cardiac magnetic resonance imaging versus computed tomography to guide transcatheter aortic valve replacement: study protocol for a randomized trial (TAVR-CMR). Trials 2022; 23:726. [PMID: 36056444 PMCID: PMC9438296 DOI: 10.1186/s13063-022-06638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background The standard procedure for the planning of transcatheter aortic valve replacement (TAVR) is the combination of echocardiography, coronary angiography, and cardiovascular computed tomography (TAVR-CT) for the exact determination of the aortic valve dimensions, valve size, and implantation route. However, up to 80% of the patients undergoing TAVR suffer from chronic renal insufficiency. Alternatives to reduce the need for iodinated contrast agents are desirable. Cardiac magnetic resonance (CMR) imaging recently has emerged as such an alternative. Therefore, we aim to investigate, for the first time, the non-inferiority of TAVR-CMR to TAVR-CT regarding efficacy and safety end-points. Methods This is a prospective, randomized, open-label trial. It is planned to include 250 patients with symptomatic severe aortic stenosis scheduled for TAVR based on a local heart-team decision. Patients will be randomized in a 1:1 fashion to receive a predefined TAVR-CMR protocol or to receive a standard TAVR-CT protocol within 2 weeks after inclusion. Follow-up will be performed at hospital discharge after TAVR and after 1 and 2 years. The primary efficacy outcome is device implantation success at discharge. The secondary endpoints are a combined safety endpoint and a combined clinical efficacy endpoint at baseline and at 1 and 2 years, as well as a comparison of imaging procedure related variables. Endpoint definitions are based on the updated 2012 VARC-2 consensus document. Discussion TAVR-CMR might be an alternative to TAVR-CT for planning a TAVR procedure. If proven to be effective and safe, a broader application of TAVR-CMR might reduce the incidence of acute kidney injury after TAVR and thus improve outcomes. Trial registration The trial is registered at ClinicalTrials.gov (NCT03831087). The results will be disseminated at scientific meetings and publication in peer-reviewed journals.
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Affiliation(s)
- Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Sebastian Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Felix Troger
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Priscilla Fink
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Mathias Pamminger
- University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kremser
- University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hanno Ulmer
- Department for Medical Statistics, Informatics and Health Economy, Medical University of Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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10
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Venturi G, Scarsini R, Pighi M, Kotronias RA, Piccoli A, Lunardi M, Del Sole P, Mainardi A, Gambaro A, Tavella D, De Maria GL, Kharbanda R, Pesarini G, Banning A, Ribichini F. Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI. Catheter Cardiovasc Interv 2022; 99:1925-1934. [PMID: 35312158 PMCID: PMC9546166 DOI: 10.1002/ccd.30156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/05/2022] [Indexed: 11/27/2022]
Abstract
The volume of contrast to creatinine clearance ratio (CV/CrCl) is a useful indicator of the risk of acute kidney injury (AKI) in patients undergoing percutaneous interventional procedures. Association between CV/CrCl and adverse outcome after transcatheter aortic valve implantation (TAVI) was suggested but it is not well established. A large retrospective multicenter cohort of 1381 patients treated with TAVI was analyzed to assess the association between CV/CrCl and the risk of AKI and mortality at 90 days and 1 year after TAVI. Patients receiving renal replacement therapy at the time of TAVI were excluded. CV/CrCl ≥ 2.2 was associated with the risk of AKI and 90 days mortality after TAVI after adjustment for age, sex, diabetes, baseline left ventricular function, baseline chronic kidney disease (CKD), previous myocardial infarction and peripheral vascular disease (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.09–1.22, p < 0.0001). Importantly, CV/CrCl was associated with the adverse outcome independently from the presence of baseline CKD (p for interaction = 0.22). CV/CrCl was independently associated with the individual components of the composite primary outcome including AKI (odds ratio: 1.18, 95% CI: 1.08–1.28, p < 0.0001) and 90 days mortality (HR: 1.90, 95% CI: 1.01–3.60, p = 0.047) after TAVI. AKI (HR: 1.94, 95% CI: 1.21–3.11, p = 0.006) but not CV/CrCl was associated with the risk of 1‐year mortality after TAVI. CV/CrCl is associated with excess renal damage and early mortality after TAVI. Procedural strategies to minimize the CV/CrCl during TAVI may improve early clinical outcomes in patients undergoing TAVI.
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Affiliation(s)
- Gabriele Venturi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Pighi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | | | - Anna Piccoli
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Mattia Lunardi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Del Sole
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Mainardi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Alessia Gambaro
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Domenico Tavella
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | | | - Rajesh Kharbanda
- John Radcliffe Oxford University Hospital, NHS Trust, Oxford, UK
| | - Gabriele Pesarini
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Adrian Banning
- John Radcliffe Oxford University Hospital, NHS Trust, Oxford, UK
| | - Flavio Ribichini
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
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11
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Ugwu JK, Ndulue JK, Sherif KA, Alliu S, Elbadawi A, Taskesen T, Hussein D, Ugwu Erugo JN, Chatila KF, Almustafa A, Khalife WI, Kumfa PN. Safety of Transcatheter Aortic Valve Replacement in Patients with Aortic Aneurysm: A Propensity-Matched Analysis. Cardiol Ther 2022; 11:143-154. [PMID: 35249199 PMCID: PMC8933596 DOI: 10.1007/s40119-022-00258-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/05/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction There is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) among patients with thoracic or abdominal aortic aneurysms (AA). Using the Nationwide Inpatient Sample (NIS) database, we explored the safety of TAVR among patients with a diagnosis of AA. Methods We queried the National Inpatient Sample database (2012–2017) for hospitalized patients undergoing TAVR, using ICD-9 and ICD-10 codes for endovascular TAVR. Reports show that > 95% of endovascular TAVR in the US is via transfemoral access, so our population are mostly patients undergoing transfemoral TAVR. Using propensity score matching, we compared the trends and outcomes of TAVR procedures among patients with versus without AA. Results From a total sample of 29,517 individuals who had TAVR procedures between January 2012 and December 2017, 910 had a diagnosis of AA. In 774 matched-pair analysis, all-cause in-hospital mortality was similar in patients with and without AA OR 0.63 [(95% CI 0.28–1.43), p = 0.20]. The median length of stay was higher in patients with AA: 4 days (IQR 2.0–7.0) versus 3 days (IQR 2.0–6.0) p = 0.01. Risk of AKI [OR 1.01 (0.73–1.39), p = 0.87], heart block requiring pacemaker placement [OR 1.17 (0.81–1.69), p = 0.40], aortic dissection [OR 2.38 (0.41–13.75), p = 0.25], acute limb ischemia [OR 0.46 (0.18–1.16), p = 0.09], vascular complications [OR 0.80 (0.34–1.89), p = 0.53], post-op bleeding [OR 1.12 (0.81–1.57), p = 0.42], blood transfusion [OR 1.20 (0.84–1.70), p = 0.26], and stroke [OR 0.58 (0.24–1.39), p = 0.25] were similar in those with and without AA. Conclusions Data from a large nationwide database demonstrated that patients with AA undergoing TAVR are associated with similar in-hospital outcomes compared with patients without AA. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-022-00258-6.
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Affiliation(s)
- Justin K. Ugwu
- Cardiovascular Disease Fellowship, MercyOne Des Moines Medical Center/Iowa Heart Center, 1111 6th Ave, Des Moines, IA 50314 USA
| | - Jideofor K. Ndulue
- Providence Medical Group, Chehalis Family Medicine, 931 S Market Blvd, Chehalis, WA 98532 USA
| | - Khaled A. Sherif
- Cardiovascular Disease Fellowship Program, University of Texas Rio Grande Valley, 5423 S McColl Rd, Edinburg, TX 78539 USA
| | - Samson Alliu
- Heart and Vascular Institute, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219 USA
| | - Ayman Elbadawi
- Interventional Cardiology Fellowship, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030 USA
| | - Tuncay Taskesen
- Cardiovascular Disease Fellowship, MercyOne Des Moines Medical Center/Iowa Heart Center, 1111 6th Ave, Des Moines, IA 50314 USA
| | - Doha Hussein
- University of Texas Medical Branch Medical School, 301 University Blvd, Galveston, TX 77555 USA
| | - Judith N. Ugwu Erugo
- Ebonyi State University Teaching Hospital, PMB 077, Abakaliki, 480001 Ebonyi State Nigeria
| | - Khaled F. Chatila
- Division of Cardiovascular Medicine, University of Texas Medical Branch, 301 University Blvd, 5.106 John Sealy Annex, Galveston, TX 77555 USA
| | - Ahmed Almustafa
- Division of Cardiovascular Medicine, University of Texas Medical Branch, 301 University Blvd, 5.106 John Sealy Annex, Galveston, TX 77555 USA
| | - Wissam I. Khalife
- Division of Cardiovascular Medicine, University of Texas Medical Branch, 301 University Blvd, 5.106 John Sealy Annex, Galveston, TX 77555 USA
| | - Paul N. Kumfa
- Division of Cardiovascular Medicine, University of Texas Medical Branch, 301 University Blvd, 5.106 John Sealy Annex, Galveston, TX 77555 USA
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12
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Acute Kidney Injury Following Transcatheter Aortic Valve Implantation: Association with Contrast Media Dosage and Contrast Media Based Risk Predication Models. J Clin Med 2022; 11:jcm11051181. [PMID: 35268271 PMCID: PMC8911230 DOI: 10.3390/jcm11051181] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 12/10/2022] Open
Abstract
The effect of contrast media (CM), delivered prior to- and during transcatheter aortic valve implantation (TAVI), on kidney function, following the procedure, is debatable. Consequently, the performance of CM-based, acute kidney injury (AKI) risk prediction models is also questionable. We retrospectively studied 210 patients that underwent TAVI. We recorded the dose of CM used prior and during TAVI, calculated the results of different AKI risk assessment models containing a CM module, and tested their association with AKI after the procedure. AKI was diagnosed in 38 patients (18.1%). The baseline estimated glomerular filtration rate (eGFR) was lower in the AKI+ group compared to AKI− group (51 ± 19.3 versus 64.5 ± 19 mL/min/1.73 mr2, respectively). While the dose of CM delivered prior to TAVI, during TAVI or the cumulative amount of both did not differ between the groups, the results of all tested risk models were higher in AKI+ patients. However, by multivariable analysis, only eGFR had a consistent independent association with AKI. We suggest that the dose of CM delivered prior or during TAVI is not associated with AKI and that the predictive power of CM based AKI risk models is, in all probability, limited to eGFR alone.
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13
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Cigarroa R, Shaqdan AW, Patel V, Selberg AM, Kandanelly RR, Erickson P, Furman D, Sodhi N, Vatterott A, Palacios IF, Passeri JJ, Vlahakes GJ, Sakhuja R, Inglessis I, Rhee EP, Lindman BR, Elmariah S. Relation of Subacute Kidney Injury to Mortality After Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 165:81-87. [PMID: 34920860 DOI: 10.1016/j.amjcard.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
Acute kidney injury after transcatheter aortic valve implantation (TAVI) has been associated with adverse outcomes; however, data are limited on the subacute changes in renal function that occur after discharge and their impact on clinical outcomes. This study investigates the relation between subacute changes in kidney function at 30 days after TAVI and survival. Patients from 2 centers who underwent TAVI and survived beyond 30 days with baseline, in-hospital, and 30-day measures of renal function were retrospectively analyzed. Patients were stratified based on change in estimated glomerular filtration rate (eGFR) from baseline to 30 days as follows: improved (≥15% higher than baseline), worsened (≤15% lower), or unchanged (values in between). Univariable and multivariable models were constructed to identify predictors of subacute changes in renal function and of 2-year mortality. Of the 492 patients who met inclusion criteria, eGFR worsened in 102 (22%), improved in 110 (22%), and was unchanged in 280 (56%). AKI occurred in 90 patients (18%) and in only 27% of patients with worsened eGFR at 30 days. After statistical adjustment, worsened eGFR at 30 days (hazard ratio vs unchanged eGFR 2.09, 95% CI 1.37 to 3.19, p <0.001) was associated with worse survival, whereas improvement in renal function was not associated with survival (hazard ratio vs unchanged eGFR 1.30, 95% CI 0.79 to 2.11, p = 0.30). Worsened renal function at 30 days after TAVI is associated with increased mortality after TAVI. In conclusion, monitoring renal function after discharge may identify patients at high risk of adverse outcomes.
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Affiliation(s)
- Ricardo Cigarroa
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Ayman W Shaqdan
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Vaiibhav Patel
- Cardiology Division, Department of Medicine, University of Michigan Hospital, Ann Arbor, Michigan
| | - Alexandra M Selberg
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Ritvik R Kandanelly
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Phoebe Erickson
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Deborah Furman
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Nishtha Sodhi
- Cardiology Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Anna Vatterott
- Cardiology Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Igor F Palacios
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan J Passeri
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Gus J Vlahakes
- Cardiac Surgery Division, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Rahul Sakhuja
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Ignacio Inglessis
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Eugene P Rhee
- Nephrology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian R Lindman
- Cardiovascular Medicine Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
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14
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Recommendations in pre-procedural imaging assessment for TAVI intervention: SIC-SIRM position paper part 2 (CT and MR angiography, standard medical reporting, future perspectives). LA RADIOLOGIA MEDICA 2022; 127:277-293. [PMID: 35129758 DOI: 10.1007/s11547-021-01434-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
Non-invasive cardiovascular imaging owns a pivotal role in the preoperative assessment of patient candidates for transcatheter aortic valve implantation (TAVI), providing a wide range of crucial information to select the patients who will benefit the most and have the procedure done safely. This document has been developed by a joined group of experts of the Italian Society of Cardiology and the Italian Society of Medical and Interventional Radiology and aims to produce an updated consensus statement about the pre-procedural imaging assessment in candidate patients for TAVI intervention. The writing committee consisted of members and experts of both societies who worked jointly to develop a more integrated approach in the field of cardiac and vascular radiology. Part 2 of the document will cover CT and MR angiography, standard medical reporting, and future perspectives.
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15
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Chandrasekhar J, Sartori S, Mehran R, Aquino M, Vogel B, Asgar AW, Webb JG, Tchetche D, Dumonteil N, Colombo A, Windecker S, Claessen BE, Ten Berg JM, Hildick-Smith D, Wijngaard P, Lefèvre T, Deliargyris EN, Hengstenberg C, Anthopoulos P, Dangas GD. Incidence, predictors, and outcomes associated with acute kidney injury in patients undergoing transcatheter aortic valve replacement: from the BRAVO-3 randomized trial. Clin Res Cardiol 2021; 110:649-657. [PMID: 33839885 DOI: 10.1007/s00392-020-01787-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 11/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is not uncommon in patients undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE We examined the incidence, predictors, and outcomes of AKI from the BRAVO 3 randomized trial. METHODS The BRAVO-3 trial included 802 patients undergoing transfemoral TAVR randomized to bivalirudin vs. unfractionated heparin (UFH). The primary endpoint of the trial was Bleeding Academic Research Consortium (BARC) type ≥ 3b bleeding at 48 h. Total follow-up was to 30 days. AKI was adjudicated using the modified RIFLE (Valve Academic Research Consortium, VARC 1) criteria through 30-day follow-up, and in a sensitivity analysis AKI was assessed at 7 days (modified VARC-2 criteria). We examined the incidence, predictors, and 30-day outcomes associated with diagnosis of AKI. We also examined the effect of procedural anticoagulant (bivalirudin or unfractionated heparin, UFH) on AKI within 48 h after TAVR. RESULTS The trial population had a mean age of 82.3 ± 6.5 years including 48.8% women with mean EuroScore I 17.05 ± 10.3%. AKI occurred in 17.0% during 30-day follow-up and was associated with greater adjusted risk of 30-day death (13.0% vs. 3.5%, OR 5.84, 95% CI 2.62-12.99) and a trend for more BARC ≥ 3b bleeding (15.1% vs. 8.6%, OR 1.80, 95% CI 0.99-3.25). Predictors of 30-day AKI were baseline hemoglobin, body weight, and pre-existing coronary disease. AKI occurred in 10.7% at 7 days and was associated with significantly greater risk of 30-day death (OR 6.99, 95% CI 2.85-17.15). Independent predictors of AKI within 7 days included pre-existing coronary or cerebrovascular disease, chronic kidney disease (CKD), and transfusion which increased risk, whereas post-dilation was protective. The incidence of 48-h AKI was higher with bivalirudin compared to UFH in the intention to treat cohort (10.9% vs. 6.5%, p = 0.03), but not in the per-protocol assessment (10.7% vs. 7.1%, p = 0.08). CONCLUSION In the BRAVO 3 trial, AKI occurred in 17% at 30 days and in 10.7% at 7 days. AKI was associated with a significantly greater adjusted risk for 30-day death. Multivariate predictors of AKI at 30 days included baseline hemoglobin, body weight, and prior coronary artery disease, and predictors at 7 days included pre-existing vascular disease, CKD, transfusion, and valve post-dilation. Bivalirudin was associated with greater AKI within 48 h in the intention to treat but not in the per-protocol analysis.
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Affiliation(s)
- Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Cardiology, Box Hill Hospital, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA.,Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Melissa Aquino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Anita W Asgar
- Institut de Cardiologie de Montreal, Montreal, Canada
| | | | | | | | | | | | - Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | | | | | | | | | | | | | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA. .,Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA.
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16
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Mosquera VX, Bouzas-Mosquera A, Vilela-González Y, Oujo-González B, Velasco-García C, Cuenca-Castillo JJ, Herrera-Noreña JM. Non-contrast transoesophageal echo-guided transapical transcatheter aortic valve replacement: 10-year experience of a renoprotective strategy. Interact Cardiovasc Thorac Surg 2021; 33:195-202. [PMID: 33792711 DOI: 10.1093/icvts/ivab080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/10/2021] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the efficacy, safety and long-term outcomes of a renoprotective non-contrast, transoesophageal echocardiography-guided transapical (TA) transcatheter aortic valve replacement (TAVR) strategy with a balloon-expandable prosthesis, as well as to determine its impact on renal function. METHODS Between 2009 and 2019, 200 consecutive patients underwent a non-contrast, transoesophageal echocardiography-guided TA TAVR with a balloon-expandable prosthesis. RESULTS The device success rate was 95.5%. Transoesophageal echocardiography-guided deployment demonstrated a low rate of procedure-related complications: 9.5% of acute kidney injury, 8% postoperative bleeding, 6% low-cardiac output, 4.5% postprocedural aortic regurgitation ≥+2, 4% implantation of permanent pacemaker and 2% stroke. There were no significant differences between preoperative and on discharge estimated glomerular filtration rate (53.9 ± 22.2 vs 54.3 ± 22.9 ml/min/1.73 m2, P = 0.60). Logistic regression analysis confirmed postoperative bleeding as an independent predictor for acute kidney injury (odds ratio (OR) 11.148, 95% confidence interval 3.537-35.140, P < 0.001). In-hospital mortality was 7.5%. The mean follow-up was 48.5 ± 39.9 months. Renal function and patient's chronic kidney disease stage did not significantly vary during follow-up. Long-term cumulative survival at 1, 5 and 10 years was 84.2 ± 0.027%, 42.9 ± 0.038% and 32.5 ± 0.044%, respectively. Renal function affected on neither in-hospital mortality nor long-term survival. CONCLUSIONS Non-contrast, transoesophageal echocardiography-guided TA TAVR is a safe and reproducible technique with a low incidence of periprocedural complications that avoids the use of contrast and mitigates the incidence of acute kidney injury.
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Affiliation(s)
- Victor X Mosquera
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Alberto Bouzas-Mosquera
- Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.,Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Yago Vilela-González
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Bárbara Oujo-González
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Carlos Velasco-García
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - José J Cuenca-Castillo
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - José M Herrera-Noreña
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
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17
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Krapf C, Altaner N, Martini J, Putzer G, Rudolf B, Grimm M, Friedrich G, Bonaros N. Intravascular Ultrasound-Guided Contrast-Free Transcatheter Aortic Valve Implantation: A Porcine Feasibility Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:254-261. [PMID: 33734901 DOI: 10.1177/1556984521995200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Patients undergoing transcatheter aortic valve implantation (TAVI) frequently present with chronic kidney disease and are therefore particularly susceptible to nephrotoxic influences like iodinated contrast media. Acute kidney injury after TAVI is a severe complication that independently predicts short- and long-term mortality. The present study investigates the feasibility of a contrast-free approach by using intravascular ultrasound (IVUS) in conjunction with fluoroscopy. METHODS Six domestic pigs (60 ± 5 kg) were anesthetized and underwent transapical implantation of a balloon-expandable transcatheter heart valve. In the control group (n = 3), the procedures were guided by fluoroscopy/angiography. In the study group (n = 3), the procedures were guided by IVUS for preimplantation evaluation, intra-procedural guidance, and post-implantation evaluation, in conjunction with fluoroscopy without contrast. The procedures were evaluated by IVUS, fluoroscopy, aortic root angiography, and explantation and dissection of the hearts. RESULTS Relevant anatomical landmarks for correct implantation were assessed by IVUS. The following annulus measurements were obtained: area (359.67 ± 29.58 mm2), perimeter (68.28 ± 2.63 mm), maximum diameter (22.20 ± 1.22 mm), minimum diameter (20.43 ± 1.12 mm), mean diameter (21.32 ± 0.70 mm), ellipticity index (1.09 ± 0.10), and area-derived diameter (21.39 ± 0.87 mm). IVUS-guided valve deployment resulted in correct expansion within the aortic annulus without signs of paravalvular leak, compromised mitral valve, or coronary obstruction. IVUS-guided post-implantation assessment confirmed circular expansion (25.88 ± 0.30 mm) of the valves. CONCLUSIONS IVUS-guided, contrast-free transapical TAVI is feasible in a porcine model.
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Affiliation(s)
- Christoph Krapf
- 27280 Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Niklas Altaner
- 27280 Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Judith Martini
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Austria
| | - Gabriel Putzer
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Austria
| | - Benjamin Rudolf
- 27280 Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Michael Grimm
- 27280 Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Guy Friedrich
- Department of Cardiology, Medical University of Innsbruck, Austria
| | - Nikolaos Bonaros
- 27280 Department of Cardiac Surgery, Medical University of Innsbruck, Austria
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18
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Iacovelli F, Pignatelli A, Cafaro A, Stabile E, Salemme L, Cioppa A, Pucciarelli A, Spione F, Loizzi F, De Cillis E, Pestrichella V, Bortone AS, Tesorio T, Contegiacomo G. Impact of contrast medium osmolality on the risk of acute kidney injury after transcatheter aortic valve implantation: insights from the Magna Graecia TAVI registry. Int J Cardiol 2020; 329:56-62. [PMID: 33359334 DOI: 10.1016/j.ijcard.2020.12.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/25/2020] [Accepted: 12/11/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is frequent and associated with adverse outcomes and mortality; to date, in such setting of patients there is no consistent evidence that either low-osmolar contrast media (LOCM) or iso-osmolar contrast medium (IOCM) are superior to the other in terms of renal safety. METHODS 697 consecutive patients not in hemodialysis treatment who underwent TAVI (327 males, mean age 81.01 ± 5.75 years, mean european system for cardiac operative risk evaluation II 6.17 ± 0.23%) were enrolled. According to osmolality of the different iodinated CM, the population was divided in 2 groups: IOCM (n = 370) and LOCM group (n = 327). Preoperatively, 40.54% of patients in IOCM vs 39.14% in LOCM group (p = 0.765) suffered from chronic kidney disease (CKD). RESULTS The incidence of AKI was significantly lower with IOCM (9.73%) than with LOCM (15.90%; p = 0.02), and such significant difference (p < 0.001) in postprocedural change of renal function parameters persisted at discharge too. The incidence of AKI was also significantly lower with IOCM in younger patients, without diabetes, anemia, coronary artery disease history, CKD, chronic or persistent atrial fibrillation, left ventricular ejection fraction ≤35%, and in patients with low operative mortality risk scores, receiving lower amounts of dye (p < 0.05 for all). Importantly, multivariate analysis identified LOCM administration as an independent risk factor for both AKI (p = 0.006) and 1-year mortality (p = 0.001). CONCLUSIONS The use of IOCM have a favorable impact on renal function with respect to LOCM, but it should be considered especially for TAVI patients at lower AKI risk.
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Affiliation(s)
- Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy.
| | - Antonio Pignatelli
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Bari, Italy
| | | | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Luigi Salemme
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Angelo Cioppa
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Armando Pucciarelli
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Francesco Spione
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Francesco Loizzi
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Tullio Tesorio
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Gaetano Contegiacomo
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Bari, Italy
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19
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Mach M, Hasan W, Andreas M, Winkler B, Weiss G, Adlbrecht C, Delle-Karth G, Grabenwöger M. Evaluating the Association between Contrast Medium Dosage and Acute Kidney Injury in Transcatheter Aortic Valve Replacement Using Different Predictive Models. J Clin Med 2020; 9:jcm9113476. [PMID: 33126601 PMCID: PMC7692089 DOI: 10.3390/jcm9113476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 12/20/2022] Open
Abstract
Recent studies have suggested that contrast medium (CM) volume is associated with acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR). However, in a high-risk elderly TAVR population, the prognostic value and ideal threshold of CM dosage for AKI is unclear. Data of 532 successive TAVR patients (age 81.1 ± 6.8 years, EuroSCORE II 4.8% ± 6.0%) were therefore retrospectively analyzed. Based on a recently published formula, the renal function (preprocedural serum creatinine: SCr) corrected ratio of CM and body weight (CM*SCr/BW) was calculated to determine the risk of postprocedural contrast-associated AKI. AKI occurred in 94 patients (18.3%) and significantly increased 1-year all-cause mortality (23.4% vs. 13.1%; p = 0.001). A significant correlation between AKI and 30-day as well as 1-year all-cause mortality was observed (p = 0.001; p = 0.007). However, no association between CM dosage or the CM*SCr/BW ratio with the occurrence of AKI was seen (p = 0.968; p = 0.442). In our all-comers, all-access cohort, we found no relationship between CM dosage, or the established risk ratio model and the occurrence of postprocedural AKI. Further research needs to be directed towards different pathophysiological causes and preventive measures as AKI impairs short- and long-term survival.
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Affiliation(s)
- Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria;
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
- Correspondence: ; Tel.: +43-140-4005-2620
| | - Waseem Hasan
- Faculty of Medicine, Imperial College London, London SW7 2AZ, UK;
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Bernhard Winkler
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
| | - Gabriel Weiss
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
| | - Christopher Adlbrecht
- Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, 1210 Vienna, Austria; (C.A.); (G.D.-K.)
| | - Georg Delle-Karth
- Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, 1210 Vienna, Austria; (C.A.); (G.D.-K.)
| | - Martin Grabenwöger
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
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20
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Kidney injury as post-interventional complication of TAVI. Clin Res Cardiol 2020; 110:313-322. [PMID: 32844282 DOI: 10.1007/s00392-020-01732-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an accepted treatment approach of aortic stenosis. In the beginning, this technique was executed in high-risk patients only. Today, intermediate-risk patients are also amenable for TAVI, as long as the transfemoral approach is chosen. Numerous predictors have been identified that could lead to periprocedural complications and are defined by patient co-morbidities as well as being inherent to the technical approach. Although vascular complications and postinterventional paravalvular regurgitation have been minimized over the past years by revised technologies and techniques, there is a prevailing individual risk brought about by the specific pathophysiology of the cardiorenal syndrome.
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21
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Ibrahim KS, Kheirallah KA, Mayyas FA, Alwaqfi NA. Predictors of Acute Kidney Injury Following Surgical Valve Replacement. Thorac Cardiovasc Surg 2020; 69:396-404. [PMID: 32711404 DOI: 10.1055/s-0040-1710318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Acute kidney injury is a serious complication after surgical valve replacement and holds increased mortality rates. OBJECTIVES To study predictors of acute kidney injury after surgical valve replacement. MATERIALS AND METHODS Patients who underwent valve surgery procedures at our center were included. Procedures included aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG. RESULTS A total of 346 patients were included. The mean age was 51.56 (16.1). Males (n = 178) comprised 51%.At the univariate level analysis, predictors of acute kidney injury were found including age, ejection fraction, hypertension, history of CAD, emergency surgery, recent myocardial infarction, diabetes, atrial fibrillation, history of heart failure, mitral regurgitation (MR), pump time >120 minutes, aortic cross clamp >90 minutes, perioperative blood transfusion, re-exploration for bleeding, use of mechanical and biologic valve in aortic position, use of biologic valve in mitral position, prolonged inotropic support, postoperative stroke, and use of angiotensin converting enzyme inhibitors (ACEi) < a month, (all p < 0.05).By Logistic regression analysis, Age (p < 0.0001, odds ratio[AOR] = 1.076), hypertension (p = 0.039, AOR = 1.829), heart failure (p = 0.019, AOR = 2.448), MR (p = 0.0001, AOR = 3.110), use of ACEi <month (p = 0.043, AOR= 2.181), pump time >120 minutes (p = 0.022, AOR = 1.797), perioperative blood transfusion (p = 0.008, AOR = 2.532), and prolonged inotropic support (p = 0.012, AOR = 2.591) were significant and independent predictors of AKI. CONCLUSION Independent predictors of acute kidney injury following valve surgeries include age, hypertension, heart failure, MR, use of ACEi <month, perioperative blood transfusion, and prolonged pump time or inotropic support.
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Affiliation(s)
- Khalid S Ibrahim
- Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan.,Princess Muna Center for Heart Diseases and Surgery, King Abdullah University Hospital, Irbid, Jordan
| | - Khalid A Kheirallah
- Department of Public Health and Community Health, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Fadia A Mayyas
- Department of Clinical Pharmacy, College of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Nizar A Alwaqfi
- Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan.,Princess Muna Center for Heart Diseases and Surgery, King Abdullah University Hospital, Irbid, Jordan
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Nagaraja V, Kapadia S. Implications of Renal Disease in Patients Undergoing Structural Interventions. Interv Cardiol Clin 2020; 9:357-367. [PMID: 32471676 DOI: 10.1016/j.iccl.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Chronic kidney disease patients have a high prevalence of severe valvular heart disease, which reduces life expectancy. Transcatheter valve interventions has revamped the way we manage severe valvular heart disease and are an attractive alternative to invasive surgery in patients with chronic kidney disease and severe valvular heart disease. This review summarizes the impact of transcatheter valve interventions in patients with severe valvular heart disease and chronic kidney disease.
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Affiliation(s)
- Vinayak Nagaraja
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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23
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Maffeo D, Bettari L, Latib A, Maiandi C, Villa E, Messina A, Saccocci M, Arneri A, Cuccia C, Troise G. Transfemoral transcatheter aortic valve replacement without contrast medium using the Medtronic CoreValve system: a single center experience. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:489-495. [DOI: 10.23736/s0021-9509.20.11083-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Krasinski Z, Krasińska B, Olszewska M, Pawlaczyk K. Acute Renal Failure/Acute Kidney Injury (AKI) Associated with Endovascular Procedures. Diagnostics (Basel) 2020; 10:diagnostics10050274. [PMID: 32370193 PMCID: PMC7277506 DOI: 10.3390/diagnostics10050274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 01/14/2023] Open
Abstract
AKI is one of the most common yet underdiagnosed postoperative complications that can occur after any type of surgery. Contrast-induced nephropathy (CIN) is still poorly defined and due to a wide range of confounding individual variables, its risk is difficult to determine. CIN mainly affects patients with underlying chronic kidney disease, diabetes, sepsis, heart failure, acute coronary syndrome and cardiogenic shock. Further research is necessary to better understand pathophysiology of contrast-induced AKI and consequent implementation of effective prevention and therapeutic strategies. Although many therapies have been tested to avoid CIN, the only potent preventative strategy involves aggressive fluid administration and reduction of contrast volume. Regardless of surgical technique—open or endovascular—perioperative AKI is associated with significant morbidity, mortality and cost. Endovascular procedures always require administration of a contrast media, which may cause acute tubular necrosis or renal vascular embolization leading to renal ischemia and as a consequence, contribute to increased number of post-operative AKIs.
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Affiliation(s)
- Zbigniew Krasinski
- Department of Vascular, Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, 61-848 Poznan, Poland;
| | - Beata Krasińska
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland;
| | - Marta Olszewska
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
- Correspondence:
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25
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Transcatheter versus surgical aortic valve replacement in low-risk patients: a meta-analysis of randomized trials. Clin Res Cardiol 2019; 109:761-775. [PMID: 31863174 DOI: 10.1007/s00392-019-01571-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has emerged as a treatment option for severe aortic stenosis in patients at intermediate or high surgical risk. However, until recently there was insufficient evidence regarding the outcomes of TAVR compared to surgical aortic valve replacement (SAVR) for patients at low risk. METHODS We conducted a meta-analysis and systematic review of all randomized trials comparing the efficacy and safety of TAVR versus SAVR in patients at low surgical risk. Risk ratios (RR) and 95% confidence intervals (CIs) were calculated, using fixed- or random-effects model. RESULTS Four trials were eligible for analysis and comprised a total of 2887 patients (1497 allocated to TAVR and 1390 allocated to SAVR group). TAVR was associated with a 39% relative risk reduction (RRR) of major adverse cardiac events (MACE) (absolute risk reduction ARR of 3.7%; RR 0.61; 95% CI 0.47-0.79); 39% RRR of overall mortality (ARR of 1.4%; RR 0.61; 95% CI 0.39-0.96) and 45% RRR of cardiovascular mortality (ARR of 1.3%; RR 0.55; 95% CI 0.33-0.90), 69% RRR of life threatening or disabling bleeding (ARR of 7.0%; RR 0.31; 95% CI 0.22-0.44), 73% RRR of new-onset atrial fibrillation (ARR of 29%; RR 0.27; 95% CI 0.20-0.35) and 73% RRR of acute kidney injury (ARR of 2.1%; RR 0.27; 95% CI 0.14-0.56) as compared with SAVR. In contrast, TAVR was associated with a 4.7-fold increased risk of new pacemaker (PM) implantation (RR 4.72; 95% CI 1.83-12.15), which was driven by use of self-expanding valves. CONCLUSION TAVR in low-risk patients is superior to SAVR for the majority of outcomes.
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Miura D, Yamada Y, Kusaba S, Nogami E, Yunoki J, Sakamoto Y, Hikichi Y, Node K, Sakaguchi Y. Influence of preoperative serum creatinine level and intraoperative volume of contrast medium on the risk of acute kidney injury after transfemoral transcatheter aortic valve implantation: a retrospective observational study. BMC Res Notes 2019; 12:484. [PMID: 31383003 PMCID: PMC6683543 DOI: 10.1186/s13104-019-4527-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to determine if contrast medium volume (CMV) is a risk factor for acute kidney injury (AKI) during transcatheter aortic valve implantation (TAVI) via a transfemoral approach performed without major complications. All TAVI procedures performed at our institution between March 2014 and March 2018 were retrospectively reviewed. AKI was diagnosed using the Acute Kidney Injury Network classification based on the Valve Academic Research Consortium-2 definition. Procedures performed via a transapical approach and those in which circulatory dynamics failed intraoperatively were excluded. Results Eighty-one (96.4%) of 100 patients scheduled for TAVI were enrolled; seven (8.6%) developed AKI and 74 (91.4%) did not. The serum creatinine (SCr) level was significantly higher (p < 0.05) and the estimated glomerular filtration rate was significantly lower in the AKI group (p < 0.05). The CMV was significantly higher in the AKI group (103 ml vs 84 ml, p < 0.05), as was the CMV × SCr/BW value (3.34 vs 1.49, p < 0.01). The area under the curve for CMV × SCr/BW was 0.9228 and the cut-off value was 2.99. The CMV, SCr, and estimated glomerular filtration rate affect the likelihood of AKI after transfemoral TAVI and a CMV × SCr/BW value > 2.99 accurately predicts AKI. Electronic supplementary material The online version of this article (10.1186/s13104-019-4527-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daisuke Miura
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan.
| | - Yasutaka Yamada
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan
| | - Shinichiro Kusaba
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan
| | - Eijiro Nogami
- Department of Thoracic and Cardiovascular Surgery, Saga University Medical Hospital, Saga, Japan
| | - Junji Yunoki
- Department of Thoracic and Cardiovascular Surgery, Saga University Medical Hospital, Saga, Japan
| | - Yoshiko Sakamoto
- Department of Cardiology, Saga University Medical Hospital, Saga, Japan
| | - Yutaka Hikichi
- Department of Cardiology, Saga University Medical Hospital, Saga, Japan
| | - Koichi Node
- Department of Cardiology, Saga University Medical Hospital, Saga, Japan
| | - Yoshiro Sakaguchi
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan
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Merchant AM, Neyra JA, Minhajuddin A, Wehrmann LE, Mills RA, Gualano SK, Kumbhani DJ, Huffman LC, Jessen ME, Fox AA. Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement. BMC Anesthesiol 2019; 19:99. [PMID: 31185915 PMCID: PMC6560735 DOI: 10.1186/s12871-019-0764-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/22/2019] [Indexed: 12/29/2022] Open
Abstract
Background Acute kidney injury after cardiac surgery significantly associates with morbidity and mortality. Despite not requiring cardiopulmonary bypass, transcatheter aortic valve replacement patients have an incidence of post-procedural acute kidney injury similar to patients who undergo open surgical aortic valve replacement. Packed red blood cell transfusion has been associated with morbidity and mortality after cardiac surgery. We hypothesized that packed red blood cell transfusion independently associates with acute kidney injury after transcatheter aortic valve replacement, after accounting for other risk factors. Methods This is a single-center retrospective cohort study of 116 patients undergoing transcatheter aortic valve replacement. Post-transcatheter aortic valve replacement acute kidney injury was defined by Kidney Disease: Improving Global Outcomes serum creatinine-based criteria. Univariate comparisons between patients with and without post-transcatheter aortic valve replacement acute kidney injury were made for clinical characteristics. Multivariable logistic regression was used to assess independent association of packed red blood cell transfusion with post-transcatheter aortic valve replacement acute kidney injury (adjusting for pre-procedural renal function and other important clinical parameters). Results Acute kidney injury occurred in 20 (17.2%) subjects. Total number of packed red blood cells transfused independently associated with post-procedure acute kidney injury (OR = 1.67 per unit, 95% CI 1.13–2.47, P = 0.01) after adjusting for pre-procedure estimated glomerular filtration rate (OR = 0.97 per ml/min/1.73m2, 95% CI 0.94–1.00, P = 0.05), nadir hemoglobin (OR = 0.88 per g/dL increase, CI 0.61–1.27, P = 0.50), and post-procedure maximum number of concurrent inotropes and vasopressors (OR = 2.09 per inotrope or vasopressor, 95% CI 1.19–3.67, P = 0.01). Conclusion Packed red blood cell transfusion, along with post-procedure use of inotropes and vasopressors, independently associate with acute kidney injury after transcatheter aortic valve replacement. Further studies are needed to elucidate the pathobiology underlying these associations.
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Affiliation(s)
- Akeel M Merchant
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, 75390-8888, USA
| | - Javier A Neyra
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, 40536, USA
| | - Abu Minhajuddin
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Lauren E Wehrmann
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, 75390-8888, USA
| | - Richard A Mills
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Sarah K Gualano
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Dharam J Kumbhani
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Lynn C Huffman
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Amanda A Fox
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, 75390-8888, USA. .,McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
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Beohar N, Doshi D, Thourani V, Jensen H, Kodali S, Zhang F, Zhang Y, Davidson C, McCarthy P, Mack M, Kapadia S, Leon M, Kirtane A. Association of Transcatheter Aortic Valve Replacement With 30-Day Renal Function and 1-Year Outcomes Among Patients Presenting With Compromised Baseline Renal Function: Experience From the PARTNER 1 Trial and Registry. JAMA Cardiol 2019; 2:742-749. [PMID: 28467527 DOI: 10.1001/jamacardio.2017.1220] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance The frequency of baseline renal impairment among high-risk and inoperable patients with severe aortic stenosis undergoing a transcatheter aortic valve replacement (TAVR) and the effect of TAVR on subsequent renal function are, to our knowledge, unknown. Objective To determine the effect of TAVR among patients with baseline renal impairment. Design, Setting, and Participants This substudy of patients with baseline renal impairment (estimated glomerular filtration rate [eGFR] ≤ 60 mL/min) and paired baseline and 30-day measures of renal function undergoing TAVR in the PARTNER 1 trial and continued access registries was conducted in 25 centers in the United States and Canada. Main Outcomes and Measures Patients were categorized with improved eGFR (30-day follow-up eGFR≥10% higher than baseline pre-TAVR), worsened eGFR (≥10% lower), or no change in renal function (neither). Baseline characteristics, 30-day to 1-year all-cause mortality, and repeat hospitalization were compared. Multivariable models were constructed to identify predictors of 1-year mortality and of improvement/worsening in eGFR. Results Of the 821 participants, 401 (48.8%) were women and the mean (SD) age for participants with improved, unchanged, or worsening eGFR was 84.90 (6.91) years, 84.37 (7.13) years, and 85.39 (6.40) years, respectively. The eGFR was 60 mL/min or lower among 821 patients (72%), of whom 345 (42%) improved, 196 (24%) worsened, and 280 (34%) had no change at 30 days. There were no differences in baseline age, body mass index, diabetes, chronic obstructive pulmonary disease, coronary artery disease, peripheral arterial disease, hypertension, pulmonary hypertension, renal or liver disease, New York Heart Association III/IV symptoms, transaortic gradient, left ventricular ejection fraction, or procedural characteristics. The group with improved eGFR had more women, nonsmokers, and a lower cardiac index. Those with worsening eGFR had a higher median Society of Thoracic Surgeons score and left ventricle mass. From 30 days to 1 year, those with improved eGFR had no difference in mortality or repeat hospitalization. Those with worsening eGFR had increased mortality (25.5% vs 19.1%, P = .07) but no significant increases in repeat hospitalization or dialysis. Predictors of improved eGFR were being female (odds ratio [OR], 1.38; 95% CI, 1.03-1.85; P = .03) and nonsmoking status (OR, 1.49; 95% CI, 1.11-1.01; P = .01); predictors of worsening eGFR were baseline left ventricle mass (OR, 1.00; 95% CI, 1.00-1.01; P = .01), smoking (OR, 1.51; 95% CI, 1.06-2.14; P = .02), and age (OR, 1.03; 95% CI, 1.00-1.05; P = .05); and predictors of 1-year mortality were baseline left ventricular ejection fraction (OR, 0.98; 95% CI, 0.97-0.99; P = .003), baseline eGFR (OR, 0.98; 95% CI, 0.96-0.99; P < .001), and worsening eGFR vs no change in eGFR (OR, 1.51; 95% CI, 1.02-2.24; P = .04). Conclusions and Relevance Baseline renal impairment was frequent among patients who underwent TAVR. While improved eGFR did not improve 1-year outcomes, worsening eGFR was associated with increased mortality. Trial Registration clinicaltrials.gov Identifier: NCT00530894.
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Affiliation(s)
- Nirat Beohar
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida
| | - Darshan Doshi
- Columbia University Medical Center/New York Presbyterian Hospital, New York
| | | | | | - Susheel Kodali
- Columbia University Medical Center/New York Presbyterian Hospital, New York
| | - Feifan Zhang
- Cardiovascular Research Foundation, New York, New York
| | - Yiran Zhang
- Cardiovascular Research Foundation, New York, New York
| | - Charles Davidson
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
| | - Patrick McCarthy
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
| | | | | | - Martin Leon
- Columbia University Medical Center/New York Presbyterian Hospital, New York
| | - Ajay Kirtane
- Columbia University Medical Center/New York Presbyterian Hospital, New York
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Arbel Y, Ben-Assa E, Puzhevsky D, Litmanowicz B, Galli N, Chorin E, Halkin A, Sadeh B, Konigstein M, Bassat OKB, Steinvil A, Bazan S, Banai S, Finkelstein A. Forced diuresis with matched hydration during transcatheter aortic valve implantation for Reducing Acute Kidney Injury: a randomized, sham-controlled study (REDUCE-AKI). Eur Heart J 2019; 40:3169-3178. [DOI: 10.1093/eurheartj/ehz343] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/29/2019] [Accepted: 05/08/2019] [Indexed: 12/17/2022] Open
Abstract
Abstract
Aims
Acute kidney injury (AKI) is a common complication following transcatheter aortic valve implantation (TAVI) and is associated with increased risk for short- and long-term mortality. In patients undergoing percutaneous coronary intervention (PCI), forced diuresis with matched hydration has been shown to reduce the incidence of AKI by ∼50%. The aim of the present study was to evaluate whether forced diuresis with matched intravenous hydration reduces AKI in patients undergoing TAVI.
Methods and results
Reducing Acute Kidney Injury (REDUCE-AKI) was a single-centre, prospective, randomized, double-blind sham-controlled clinical trial, designed to examine the effect of an automated matched saline infusion with urine output for the prevention of AKI in patients undergoing TAVI. A total of 136 TAVI patients were randomized, 68 in each group. Mean age was 83.9 ± 5 years and 41.2% were males. There were no differences in baseline characteristics between the two groups. The rate of AKI was not statistically different between the groups (25% in the active group vs. 19.1% in the sham group, P = 0.408). There was a significant increase in long-term mortality in the active group (27.9% vs. 13. 2% HR 3.744, 95% CI 1.51–9.28; P = 0.004). The study was terminated prematurely by the Data Safety Monitoring Board for futility and a possible signal of harm.
Conclusions
Unlike in PCI, forced diuresis with matched hydration does not prevent AKI in patients undergoing TAVI, and might be associated with increased long-term mortality. Future studies should focus on understanding the mechanisms behind these findings.
Clinicaltrials.gov registration
NCT01866800, 30 April 2013.
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Affiliation(s)
- Yaron Arbel
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Eyal Ben-Assa
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Daniela Puzhevsky
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Batia Litmanowicz
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Naama Galli
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Ehud Chorin
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Amir Halkin
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Ben Sadeh
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Maayan Konigstein
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Orit Kliuk-Ben Bassat
- Department of Nephrology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Samuel Bazan
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
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Incidence of Acute Kidney Injury in Patients with Chronic Renal Insufficiency: Transcatheter versus Surgical Aortic Valve Replacement. J Interv Cardiol 2019; 2019:9780415. [PMID: 31772554 PMCID: PMC6739800 DOI: 10.1155/2019/9780415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/14/2019] [Indexed: 01/06/2023] Open
Abstract
Objectives The objective of this study is to determine incidence of acute kidney injury (AKI) associated with transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients with preexisting chronic kidney disease. Background The incidence of AKI in patients with preexisting renal insufficiency undergoing TAVR versus SAVR is not well described. Methods All patients with preexisting chronic kidney disease who underwent SAVR for aortic stenosis with or without concomitant coronary artery bypass grafting or TAVR from 5/2008 to 6/2017. Patients requiring preoperative hemodialysis were excluded. Chronic kidney disease was defined as an estimated glomerular filtrate rate (eGFR) of < 60 mL/min/1.73 m2. The incidence of postoperative AKI was compared using the RIFLE classification system for acute kidney injury. Results A total of 406 SAVR patients and 407 TAVR patients were included in this study. TAVR patients were older and had lower preoperative eGFR as compared to SAVR patients. Covariate adjustment using propensity score between the two groups showed that SAVR patients were more likely to have a more severe degree of postoperative AKI as compared to TAVR patients (OR = 4.75; 95% CI: 3.15, 7.17; p <.001). SAVR patients were more likely to require dialysis postoperatively as compared to TAVR patients (OR = 4.55; 95% CI: 1.29, 15.99; p <.018). Conclusion In patients with preexisting chronic kidney disease, TAVR was associated with significantly less AKI as compared to SAVR.
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31
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Nunes Filho AC, Katz M, Campos CM, Carvalho LA, Siqueira DA, Tumelero RT, Portella AL, Esteves V, Perin MA, Sarmento-Leite R, Lemos Neto PA, Tarasoutchi F, Bezerra HG, de Brito FS. Impacto del daño renal agudo en el seguimiento a corto y a largo plazo tras el implante percutáneo de válvula aórtica. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2017.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Ma M, Gao WD, Gu YF, Wang YS, Zhu Y, He Y. Clinical effects of acute kidney injury after transcatheter aortic valve implantation: a systematic review and meta-analysis. Intern Emerg Med 2019; 14:161-175. [PMID: 30173298 DOI: 10.1007/s11739-018-1935-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022]
Abstract
Several observational studies have shown that postoperative acute kidney injury (AKI) may significantly worsen the prognosis of a transcatheter aortic valve implantation (TAVI). The purpose of this systematic review and meta-analysis is to evaluate the recent evidence on the impact of AKI on clinical outcomes following TAVI. A comprehensive search in PubMed, Embase and the Cochrane Library was performed for relevant studies by two independent investigators. We pooled the odds ratio (OR) from individual studies, and performed heterogeneity, quality assessment and publication bias analysis. Forty-three eligible studies comprising 544,112 patients were included. Postoperative AKI not only significantly increased the risk for short-term and long-term all-cause mortality (OR 6.25, 95% CI 5.72-6.83, P < 0.00001; OR 3.49, 95% CI 2.78-4.40, P < 0.00001, respectively), but also increased the risk for early myocardial infarction (OR 3.98, 95% CI 1.90-8.31, P = 0.0002), major and life-threatening bleeding (OR 1.51, 95% CI 1.12-2.03, P = 0.007; OR 2.35, 95% CI 1.80-3.06, P < 0.00001, respectively), major vascular complications (OR 1.69, 95% CI 1.30-2.18, P < 0.0001), need for blood transfusion (OR 2.15, 95% CI 1.89-2.46, P < 0.00001) renal replacement therapy (OR 22.36, 95% CI 11.88-42.12, P = 0.0002) and cerebrovascular accidents (OR 1.92, 95% CI 1.23-2.98, P = 0.004). Acute kidney injury following TAVI is associated with increased postoperative mortality and morbidity. Future efforts are required to determine whether early prevention of post-procedural AKI after TAVI impacts upon clinical outcomes.
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Affiliation(s)
- Min Ma
- Department of Cardiology, The Sixth People's Hospital of Chengdu, Chengdu, 610051, China
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Street, Chengdu, 610041, China
| | - Wei-Dong Gao
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, 529030, Guangduo, China
| | - Yun-Fei Gu
- Department of Cardiology, LuoYang Central Hospital Affiliated to ZhengZhou University, No 288 Zhongzhou Road, Luoyang, 471000, China
| | - Yu-Shu Wang
- Department of Cardiology, The First People's Hospital of Chengdu, Chengdu, 610016, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Street, Chengdu, 610041, China
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Street, Chengdu, 610041, China.
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Hensey M, Murdoch DJ, Sathananthan J, Wood DA, Webb JG. Impact of Chronic Kidney Disease on Decision Making and Management in Transcatheter Aortic Valve Interventions. Can J Cardiol 2018; 35:1188-1194. [PMID: 30910248 DOI: 10.1016/j.cjca.2018.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/08/2018] [Accepted: 11/20/2018] [Indexed: 01/28/2023] Open
Abstract
The coexistence of chronic kidney disease (CKD) and severe aortic stenosis (AS) is common, and the prevalence of both is rising. The 2 conditions are inherently linked in that significant CKD may accelerate the development of AS and severe AS may result in deteriorating kidney function. The volume of and indications for transcatheter aortic valve implantation (TAVI) procedures are ever-increasing, and there are many challenges that need to be considered in patients with concomitant severe AS and CKD being assessed for TAVI. Throughout the process of working these patients up for definitive management of their valvular heart disease, the presence of CKD impacts on diagnostic investigations, treatment decisions, and therapeutic interventions. Herein we review the current literature regarding TAVI in patients with CKD focusing on the decision-making process and specific risks involved in TAVI and CKD. We also provide specific practical strategies to best manage this challenging patient cohort.
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Affiliation(s)
- Mark Hensey
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dale J Murdoch
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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35
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Higuchi R, Tobaru T, Hagiya K, Saji M, Takamisawa I, Shimizu J, Iguchi N, Takanashi S, Takayama M. Renoprotective Transcatheter Aortic Valve Implantation Without Contrast Media. Int Heart J 2018; 59:1469-1472. [PMID: 30249922 DOI: 10.1536/ihj.17-588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The therapeutic role of transcatheter aortic valve implantation (TAVI) in high surgical risk or inoperable cases has been established. Most of the candidates for TAVI are elderly and have multiple comorbidities including chronic kidney disease. However, contrast-enhanced computed tomography and coronary angiography, both of which require iodine contrast media, are essential for pre-procedural planning. In addition, TAVI could have adverse effects on kidney function including contrast media-induced nephrotoxicity. Acute kidney injury following TAVI has been reported to be related to poor prognosis. In a case with advanced renal dysfunction, we successfully avoided post-procedural acute kidney injury by performing pre-procedural evaluation using minimal contrast and TAVI without contrast media. If anatomical conditions and experiences of the heart team are adequate, renoprotective TAVI should be a favorable therapy for patients with aortic stenosis complicated by renal dysfunction.
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Affiliation(s)
| | | | | | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute
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36
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Atherosclerosis on CT Angiogram Predicts Acute Kidney Injury After Transcatheter Aortic Valve Replacement. AJR Am J Roentgenol 2018; 211:677-683. [DOI: 10.2214/ajr.17.19340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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37
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Fefer P, Bogdan A, Grossman Y, Berkovitch A, Brodov Y, Kuperstein R, Segev A, Guetta V, Barbash IM. Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2018; 7:JAHA.118.009038. [PMID: 29987119 PMCID: PMC6064853 DOI: 10.1161/jaha.118.009038] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Rapid ventricular pacing (RVP) is used commonly during transcatheter aortic valve replacement (TAVR). Little is known about the safety and clinical consequences of this step. The aim of this study was to assess the impact of RVP on immediate and long‐term clinical outcomes in a large cohort of non‐selected TAVR patients. Method and Results The study included 412 consecutive patients undergoing TAVR with a mean age of 82±7 years, of which 47% were male. Patients were divided according to the number of RVPs during the TAVR procedure comparing patients undergoing no pacing (0), 1 to 2, and ≥3 pacing episodes (3+). Patients undergoing 3+ pacing episodes were significantly more likely to develop new atrial fibrillation (5.6% versus 7.3% versus 15%, respectively, for 0, 1–2, and 3+ groups, P=0.047), acute kidney injury (AKI) (18% versus 18% versus 28%, respectively, P<0.001), prolonged procedural hypotension (0%, 16%, and 25%, respectively; P<0.001), and suffered greater in‐hospital mortality (1.7%, 1.7%, and 6.5%, respectively, P=0.045), and 1‐year mortality (11.1%, 7.7%, and 18%, respectively, P=0.015). Multivariate Cox regression analysis indicated that acute kidney injury (OR 3.27 [1.763–6.09], P<0.001), euroSCORE II (OR 1.06 per unit [1.01–1.12], P=0.03), and 3+ pacing episodes (OR 2.35 [1.18–4.7], P=0.02) were the only independent predictors for 1‐year mortality. Conclusions In patients undergoing TAVR, multiple RVP episodes and prolonged RVP duration are associated with adverse outcomes including short‐ and long‐term mortality. Thus, operators should attempt to minimize the use of RVP, especially in patients who are at risk for post‐procedural acute kidney injury.
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Affiliation(s)
- Paul Fefer
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrada Bogdan
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoni Grossman
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Berkovitch
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yafim Brodov
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rafael Kuperstein
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel M Barbash
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hell MM, Biburger L, Marwan M, Schuhbaeck A, Achenbach S, Lell M, Uder M, Arnold M. Prediction of fluoroscopic angulations for transcatheter aortic valve implantation by CT angiography: influence on procedural parameters. Eur Heart J Cardiovasc Imaging 2018; 18:906-914. [PMID: 27461209 DOI: 10.1093/ehjci/jew144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/16/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Repeated angiograms to achieve an exactly orthogonal visualization of the aortic valve plane can substantially contribute to the total contrast amount required for transcatheter aortic valve implantation (TAVI). We investigated whether pre-procedural identification of an optimal fluoroscopic projection by cardiac computed tomography (CT) can significantly reduce the amount of a procedure-related contrast agent compared with angiographic determination of suitable angulations. Methods and results Eighty consecutive patients (81 ± 5 years, 55% male) with symptomatic severe aortic valve stenosis and normal renal function who underwent cardiac CT prior to TAVI were prospectively randomized. In 40 patients, a CT-predicted suitable angulation was used for the first aortic angiogram (CT cohort); in the other 40 patients, the first aortogram was acquired at LAO 10°/cranial 10 (angiography cohort). Additional aortograms were performed if no satisfactory view of the aortic valve plane was obtained. The number of aortograms needed to achieve a satisfactory fluoroscopic projection (1.2 ± 0.6 vs. 3.2 ± 1.7; P < 0.001) and the total amount of contrast agent per TAVI procedure were significantly lower in the CT cohort (95 ± 21 vs. 125 ± 36 mL; P < 0.001). Incidence of acute kidney injury was not significantly different. There was no significant difference regarding radiation dose, time of procedure, degree of post-procedural aortic regurgitation, complications and 30-day mortality between the cohorts. Conclusion Pre-procedural identification of a suitable fluoroscopic projection by cardiac CT significantly reduces a procedural contrast agent volume required for TAVI.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Lukas Biburger
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Annika Schuhbaeck
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Michael Lell
- Department of Radiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Maximilliansplatz 1, 91054 Erlangen, Germany
| | - Michael Uder
- Department of Radiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Maximilliansplatz 1, 91054 Erlangen, Germany
| | - Martin Arnold
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
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39
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Zivkovic N, Elbaz-Greener G, Qiu F, Arbel Y, Cheema AN, Dvir D, Fefer P, Finkelstein A, Fremes SE, Radhakrishnan S, Rodés-Cabau J, Shuvy M, Wijeysundera HC. Bedside risk score for prediction of acute kidney injury after transcatheter aortic valve replacement. Open Heart 2018; 5:e000777. [PMID: 29862034 PMCID: PMC5976119 DOI: 10.1136/openhrt-2018-000777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/01/2018] [Indexed: 01/02/2023] Open
Abstract
Background Acute kidney injury (AKI) is a common post-transcatheter aortic valve replacement (TAVR) complication associated with a poor prognosis. We sought to create a risk calculator using information that would be available during the work-up period. Methods Data were obtained from a multicentre TAVR registry (n=1993) with cases from 1 January 2012 to 31 December 2015. We used logistic regression to create a risk calculator to predict AKI as defined by the Valve Academic Research Consortium Guidelines. We internally validated our risk calculator using bootstrapping, and evaluated model discrimination and calibration. Results A simple risk score was derived with six variables, including New York Heart Association functional classification class 4, non-femoral access site, valve-in-valve procedure, haemoglobin, creatinine clearance and weight in kilograms. The score was able to predict the absolute risk of AKI from 1% to 72%. The model showed good discrimination with c-statistic 0.713, with good agreement between predicted and observed AKI rates across quintiles of risk. Conclusions This is the first risk calculator to assess post-TAVR risk of AKI. We found that information known pre-procedurally can be used to predict AKI. This may allow for more informed decision-making as well as identifying high-risk patients.
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Affiliation(s)
- Nevena Zivkovic
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gabby Elbaz-Greener
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Feng Qiu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asim N Cheema
- Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Danny Dvir
- Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Paul Fefer
- Heart Institute, Sheba Medical Center, Tel HaShomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stephen E Fremes
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sam Radhakrishnan
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mony Shuvy
- Heart Institute, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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40
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Mayr A, Klug G, Reinstadler SJ, Feistritzer HJ, Reindl M, Kremser C, Kranewitter C, Bonaros N, Friedrich G, Feuchtner G, Metzler B. Is MRI equivalent to CT in the guidance of TAVR? A pilot study. Eur Radiol 2018; 28:4625-4634. [PMID: 29736853 DOI: 10.1007/s00330-018-5386-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/11/2018] [Accepted: 02/14/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To compare a comprehensive cardiovascular magnetic resonance imaging (MRI) protocol with contrast-enhanced computed tomography angiography (CTA) for guidance in transcatheter aortic valve replacement (TAVR) evaluation. METHODS AND RESULTS Non-contrast three-dimensional (3D) 'whole heart' MRI imaging for aortic annulus sizing and measurements of coronary ostia heights, contrast-enhanced MRI angiography (MRA) for evaluation of transfemoral routes as well as aortoiliofemoral-CTA were performed in 16 patients referred for evaluation of TAVR. Aortic annulus measurements by MRI and CTA showed a very strong correlation (r=0.956, p<0.0001; effective annulus area for MRI 430±74 vs. 428±78 mm2 for CTA, p=0.629). Regarding decision for valve size there was complete consistency between MRI and CTA. Moreover, vessel luminal diameters and angulations of aortoiliofemoral access as measured by MRA and CTA showed overall very strong correlations (r= 0.819 to 0.996, all p<0.001), the agreement of minimal vessel diameter between the two modalities revealed a bias of 0.02 mm (upper and lower limit of agreement: 1.02 mm and -0.98 mm). CONCLUSIONS In patients referred for TAVR, MRI measurements of aortic annulus and minimal aortoiliofemoral diameters showed good to excellent agreement. Decisions based on MRI measurements regrading prosthesis sizing and transfemoral access would not have modified TAVR-strategy as compared to a CTA-based choice. KEY POINTS • 'Whole heart' MRI and CTA measurements of aortic annulus correlate very strongly. • MRI- and CTA-based prostheses sizing are in excellent agreement. • MRA and CTA equally guide TAVR access strategy.
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Affiliation(s)
- Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Hans-Josef Feistritzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christian Kremser
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christof Kranewitter
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Nikolaos Bonaros
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Guy Friedrich
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Gudrun Feuchtner
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
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41
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Kumar N, Garg N. Acute kidney injury after aortic valve replacement in a nationally representative cohort in the USA. Nephrol Dial Transplant 2018; 34:295-300. [DOI: 10.1093/ndt/gfy097] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/08/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nilay Kumar
- Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Neetika Garg
- Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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42
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Würschinger F, Wittmann S, Goldfuß S, Zech N, Debl K, Hilker M, Graf BM, Zausig YA. Complications after transcatheter aortic valve implantation using transfemoral and transapical approach in general anaesthesia. PLoS One 2018; 13:e0193558. [PMID: 29652895 PMCID: PMC5898702 DOI: 10.1371/journal.pone.0193558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/06/2018] [Indexed: 12/30/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat degenerative heart valve disease. The implantation requires a highly specific and interdisciplinary management approach. Currently, TAVI is performed with the patient under local or general anaesthesia. Methods This study was a retrospective analysis of all TAVI procedures performed at the University Hospital of Regensburg between January 2009 and July 2015. All pre-, intra and postoperative data focusing on perioperative complications were recorded. Results A total of 853 transfemoral- and transapical-TAVI patients were included in the study. All patients underwent general anaesthesia. The ASA classifications were primarily 3–4. The average logistic EuroScores for the transfemoral- and transapical-TAVI patients were 18 ± 12% and 21 ± 15% (p = 0.002), respectively. The anaesthesia coverage time was 170 ± 49 min., including 37 ± 12 minutes for anaesthetic management. Overall, 458 complications were recorded; with pneumonia, acute renal failure, indication for a permanent pacemaker and non-extubation in the operating theatre the most frequently recorded complications. Conclusion In the present study, we showed that our patients’ outcomes are comparable to those reported in the available literature. Compared to TF, TA patients show an overall worse physical condition as well as a higher perioperative morbidity and mortality. Consequently TA patients need additional care and should only be operated in appropriately experienced medical centres.
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Affiliation(s)
- Fabian Würschinger
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Sigrid Wittmann
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Sophia Goldfuß
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Nina Zech
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Kurt Debl
- Medizinische Klinik II, Intensivmedizin, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Michael Hilker
- Klinik für Herz-Thorax-Chirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Bernhard M. Graf
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - York A. Zausig
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
- * E-mail:
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43
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Frequency and Prognostic Significance of Acute Kidney Recovery in Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2018; 121:634-641. [PMID: 29329828 DOI: 10.1016/j.amjcard.2017.11.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 01/31/2023]
Abstract
Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is associated with increased mortality. As significant hemodynamic improvement may occur with relief of aortic stenosis, we hypothesized that TAVI patients may demonstrate the opposite phenomena: acute kidney recovery (AKR). We studied the incidence and predictors of AKR in post-TAVI patients. A total of 366 consecutive patients underwent TAVI (January 2012 to January 2017) at a single center. We defined AKR as a 25% improvement in glomerular filtration rate (GFR) at 48 hours after TAVI. AKI-creatinine (Cr) was defined as an increase in Cr of ≥0.3 mg/dl at 48 hours. Patients were categorized in 3 groups: AKR (≥25% increase in GFR), unchanged GFR, and AKI-GFR (inverse definition of AKR, ≥25% decrease in GFR). Multivariable logistic regression defined independent predictors of AKR. AKR occurred in 1/3 of patients. AKI-Cr occurred in 13% of patients, whereas AKI-GFR occurred similarly in 15%. AKR and AKI occurred most frequently in patients with chronic kidney disease (CKD: GFR ≤ 60 ml/min/1.73 m2). Independent predictors of AKR-GFR by multivariable analysis were male gender, lack of chronic β-blocker utilization, and presence of CKD. Notably, left ventricular dysfunction and contrast volume were not predictive of AKR. Transfusion occurred less frequently among patients with AKR compared with patients with AKI-GFR (11% vs 26%, p = 0.03). Death occurred in 0% of AKR patients versus 9.3% of AKI-GFR patients (p <0.01). In conclusion, this is the first report of AKR after TAVI. Patients with CKD, male gender, and lack of pre-TAVI beta blockade were more likely to demonstrate AKR.
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44
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Arsalan M, Ungchusri E, Farkas R, Johnson M, Kim RJ, Filardo G, Pollock BD, Szerlip M, Mack MJ, Holper EM. Novel renal biomarker evaluation for early detection of acute kidney injury after transcatheter aortic valve implantation. Proc (Bayl Univ Med Cent) 2018; 31:171-176. [PMID: 29706810 DOI: 10.1080/08998280.2017.1416235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/18/2017] [Indexed: 12/19/2022] Open
Abstract
Acute kidney injury (AKI) following transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The biomarkers neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) are predictive of AKI after cardiac surgery, but there is little data regarding these biomarkers after TAVI. We evaluated the associations between NGAL, KIM-1, and IL-18 levels and the incidence and severity of AKI and changes in serum creatinine after TAVI. This was a prospective pilot study of 66 TAVI cases. Urinary biomarkers were measured at baseline and at 2, 4, and 12 hours after TAVI. Demographics, procedural features, and renal function until discharge were compared between patients with and without subsequent AKI. Seventeen patients (25.8%) developed AKI postoperatively (stage 1, n = 14; stage 2, n = 1; stage 3, n = 2). There were no significant differences in unadjusted mean NGAL, KIM-1, and IL-18 levels between patients with and without AKI at 2, 4, and 12 hours following surgery. After adjusting for the Society of Thoracic Surgeons risk of mortality, this study of three urinary biomarkers showed no association with AKI or creatinine after TAVI. Ongoing efforts to predict and modify the risk of AKI after TAVI remain challenging.
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Affiliation(s)
- Mani Arsalan
- Cardiac Surgery, Kerckhoff Klinik, Bad Neuheim, Germany
| | | | | | | | - Rebeca J Kim
- Baylor Scott & White Research Institute, Plano, Texas
| | - Giovanni Filardo
- The Heart Hospital Baylor Plano, Plano, Texas.,Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas
| | - Benjamin D Pollock
- Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas
| | | | | | - Elizabeth M Holper
- Baylor Scott & White Research Institute, Plano, Texas.,The Heart Hospital Baylor Plano, Plano, Texas
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45
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Nunes Filho ACB, Katz M, Campos CM, Carvalho LA, Siqueira DA, Tumelero RT, Portella ALF, Esteves V, Perin MA, Sarmento-Leite R, Lemos Neto PA, Tarasoutchi F, Bezerra HG, de Brito FS. Impact of Acute Kidney Injury on Short- and Long-term Outcomes After Transcatheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2018; 72:21-29. [PMID: 29358043 DOI: 10.1016/j.rec.2017.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. METHODS Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. RESULTS The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). CONCLUSIONS Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI.
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Affiliation(s)
| | - Marcelo Katz
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carlos M Campos
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz A Carvalho
- Department of Interventional Cardiology, Hospital Pró-Cardíaco, Rio de Janeiro, Brazil
| | - Dimytri A Siqueira
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Rogério T Tumelero
- Department of Interventional Cardiology, Hospital São Vicente de Paulo, Passo Fundo, Brazil
| | | | - Vinícius Esteves
- Department of Interventional Cardiology, Rede D'OR São Luiz, São Paulo, Brazil
| | - Marco A Perin
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Pedro A Lemos Neto
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Flavio Tarasoutchi
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Hiram G Bezerra
- Cardiac Catheterization Laboratory, UH Cleveland Medical Center, Cleveland, United States
| | - Fábio S de Brito
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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46
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Schneider C, Brumberg A, Roller FC, Rixe J, Roth P, Krombach GA. Multimodality imaging evaluation before transcatheter aortic valve implantation: incidence of contrast medium-induced acute kidney injury, risk factors and prognosis. Clin Radiol 2018; 73:502.e1-502.e8. [PMID: 29329731 DOI: 10.1016/j.crad.2017.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 11/27/2017] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the incidence, risk factors, and prognostic implications of contrast medium-induced acute kidney injury (CI-AKI) in patients undergoing transcatheter aortic valve implantation (TAVI) evaluation. MATERIALS AND METHODS Datasets from 98 out of 207 consecutive patients referred for multidetector computed tomography (MDCT) for TAVI evaluation were eligible for evaluation and were analysed retrospectively. The incidence of CI-AKI was correlated to outcome and to potential risk factors: kidney function (estimated glomerular filtration rate [eGFR]), heart failure, diabetes, amount of contrast medium, and duration of examination period. RESULTS CI-AKI occurred in 67 patients (68.4%) and mainly correlated with eGFR (p=0.01) and the amount of contrast medium as a function of eGFR (p=0.04). CI-AKI occurred before TAVI in 36 (53.7%) patients of which 13 (19.4%) did not undergo TAVI. In-hospital all-cause mortality was 21.4%, and of those 21 patients, 18 (85.7%) had CI-AKI and nine (42.9%) did not undergo TAVI. One-year all-cause mortality was 39.8%, and of those 39 patients who died within 1 year, 31 (79.5%) had CI-AKI. CONCLUSION CI-AKI mostly occurs already before TAVI as a consequence of pre-procedural imaging, which therefore represents the main contributor for CI-AKI in relation to TAVI. Regarding the observation that some patients will ultimately have no benefit because TAVI is not performed and the poor prognosis linked to CI-AKI should encourage improvement in patient selection when referring to pre-procedural imaging.
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Affiliation(s)
- C Schneider
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany.
| | - A Brumberg
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany
| | - F C Roller
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany
| | - J Rixe
- Department of Cardiology and Angiology, University Hospital Giessen, Giessen, Germany
| | - P Roth
- Department of Cardiac Surgery, University Hospital Giessen, Giessen, Germany
| | - G A Krombach
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany
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47
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Choi YJ, Ahn CM, Kim DR, Hong GR, Ko YG, Hong MK. Contrast-free (Zero-contrast) TAVR for Severe Aortic Stenosis in Patient with Chronic Kidney Disease. J Lipid Atheroscler 2018. [DOI: 10.12997/jla.2018.7.1.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yeon-Jik Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Da-Rae Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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48
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Ram P, Mezue K, Pressman G, Rangaswami J. Acute kidney injury post-transcatheter aortic valve replacement. Clin Cardiol 2017; 40:1357-1362. [PMID: 29251358 DOI: 10.1002/clc.22820] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a treatment option in high-risk patients with severe aortic stenosis who are not surgical candidates. In light of emerging evidence, it is being increasingly performed even in intermediate-risk patients in recent years. Patients who develop acute kidney injury (AKI) following TAVR are known to have worse outcomes. The objective of this concise review was to identify the prevalence and the impact of AKI following TAVR on patient outcomes by including the most recent literature in our search. After a thorough search on MEDLINE, Google Scholar, and PubMed, we included all literature relevant to AKI following TAVR. We found that AKI was caused by a variety of reasons, such as hemodynamic instability during rapid pacing, blood transfusion, periprocedural embolization, and use of contrast medium, to name a few. In patients who developed AKI following TAVR, 30-day and 1-year mortality were increased. Further, in these patients, length and cost of hospital stay were increased as well. Preventive measures such as optimal periprocedural hydration, careful contrast use, and techniques to prevent embolization during device implantation have been tried with limited success. Given that TAVR is expected to be increasingly performed, this review aimed to summarize the rapidly expanding currently available literature in an effort to reduce procedural complications and thereby improve patient outcomes.
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Affiliation(s)
- Pradhum Ram
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Kenechukwu Mezue
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Gregg Pressman
- Heart and Vascular Institute, Division of Cardiology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Janani Rangaswami
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
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49
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The Plan Was to Replace the Valve, Not the Kidneys. JACC Cardiovasc Interv 2017; 10:2076-2077. [PMID: 29050624 DOI: 10.1016/j.jcin.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 09/12/2017] [Indexed: 11/22/2022]
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50
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Ferro CJ, Law JP, Doshi SN, de Belder M, Moat N, Mamas M, Hildick-Smith D, Ludman P, Townend JN. Dialysis Following Transcatheter Aortic Valve Replacement: Risk Factors and Outcomes. JACC Cardiovasc Interv 2017; 10:2040-2047. [DOI: 10.1016/j.jcin.2017.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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