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Langenbach IL, Langenbach MC, Mayrhofer T, Foldyna B, Maintz D, Klein K, Wienemann H, Krug KB, Hellmich M, Adam M, Naehle CP. Reduction of contrast medium for transcatheter aortic valve replacement planning using a spectral detector CT: a prospective clinical trial. Eur Radiol 2024; 34:4089-4099. [PMID: 37979008 PMCID: PMC11166752 DOI: 10.1007/s00330-023-10403-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/25/2023] [Accepted: 09/17/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION This study investigated the use of dual-energy spectral detector computed tomography (CT) and virtual monoenergetic imaging (VMI) reconstructions in pre-interventional transcatheter aortic valve replacement (TAVR) planning. We aimed to determine the minimum required contrast medium (CM) amount to maintain diagnostic CT imaging quality for TAVR planning. METHODS In this prospective clinical trial, TAVR candidates received a standardized dual-layer spectral detector CT protocol. The CM amount (Iohexol 350 mg iodine/mL, standardized flow rate 3 mL/s) was reduced systematically after 15 patients by 10 mL, starting at 60 mL (institutional standard). We evaluated standard, and 40- and 60-keV VMI reconstructions. For image quality, we measured signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and diameters in multiple vessel sections (i.e., aortic annulus: diameter, perimeter, area; aorta/arteries: minimal diameter). Mixed regression models (MRM), including interaction terms and clinical characteristics, were used for comparison. RESULTS Sixty consecutive patients (mean age, 79.4 ± 7.5 years; 28 females, 46.7%) were included. In pre-TAVR CT, the CM reduction to 40 mL is possible without affecting the image quality (MRM: SNR: -1.1, p = 0.726; CNR: 0.0, p = 0.999). VMI 40-keV reconstructions showed better results than standard reconstructions with significantly higher SNR (+ 6.04, p < 0.001). Reduction to 30 mL CM resulted in a significant loss of quality (MRM: SNR: -12.9, p < 0.001; CNR: -13.9, p < 0.001), regardless of the reconstruction. Across the reconstructions, we observed no differences in the metric evaluation (p > 0.914). CONCLUSION Among TAVR candidates undergoing pre-interventional CT at a dual-layer spectral detector system, applying 40 mL CM is sufficient to maintain diagnostic image quality. VMI 40-keV reconstructions improve the vessel attenuation and are recommended for evaluation. CLINICAL RELEVANCE STATEMENT Contrast medium reduction to 40 mL in pre-interventional transcatheter aortic valve replacement CT using dual-energy CT maintains image quality, while 40-keV virtual monoenergetic imaging reconstructions enhance vessel attenuation. These results offer valuable recommendations for interventional transcatheter aortic valve replacement evaluation and potentially improve nephroprotection in patients with compromised renal function. KEY POINTS • Patients undergoing transcatheter aortic valve replacement (TAVR), requiring pre-interventional CT, are often multimorbid with impaired renal function. • Using a spectral detector dual-layer CT, contrast medium reduction to 40 mL is feasible, maintaining diagnostic image quality. • The additional application of virtual monoenergetic image reconstructions with 40 keV improves vessel attenuation significantly in clinical practice.
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Affiliation(s)
- Isabel L Langenbach
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany.
| | - Marcel C Langenbach
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
- School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Konstantin Klein
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Hendrik Wienemann
- Clinic III for Internal Medicine, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Kathrin B Krug
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Matti Adam
- Clinic III for Internal Medicine, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. J Am Coll Cardiol 2024; 83:1579-1613. [PMID: 38493389 DOI: 10.1016/j.jacc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2024; 17:e000129. [PMID: 38484039 DOI: 10.1161/hcq.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Affiliation(s)
- Hani Jneid
- ACC/AHA Joint Committee on Clinical Data Standards liaison
- Society for Cardiovascular Angiography and Interventions representative
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Song D, Sattar Y, Faisaluddin M, Talib U, Patel N, Shahid I, Taha A, Raheela F, Sengodon P, Riasat M, Shah V, Gonuguntla K, Alam M, Elgendy I, Daggubati R, Alraies MC. Cardiovascular Outcomes of Transcatheter Aortic Valve Implantation in Patients With Chronic Kidney Disease in Octogenarian Population. Am J Cardiol 2024; 211:163-171. [PMID: 38043436 DOI: 10.1016/j.amjcard.2023.07.083] [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: 04/03/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 12/05/2023]
Abstract
Limited data are available regarding in-hospital outcomes of transcatheter aortic valve implantation (TAVI) in the octogenarian population with chronic kidney disease (CKD). We sought to study the cardiovascular outcomes of TAVI in CKD hospitalization with different stages at the national cohort registry. We used the National Inpatient Sample database to compare TAVI CKD low-grade (LG) (stage I to IIIa, b) versus TAVI CKD high-grade (HG) (stage IV to V) in octogenarians. Outcomes such as inpatient mortality, cardiogenic shock, new permanent pacemaker implantation, acute kidney injury), sudden cardiac arrest, mechanical circulatory support, major bleeding, transfusion, and resource utilization were compared between the 2 cohorts. A total of 74,766 octogenarian patients (TAVI CKD-HG n = 12,220; TAVI CKD-LG n = 62,545) were included in our study. On matched analysis, TAVI CKD-HG had higher odds of in-hospital mortality (adjusted odds ratio [aOR] 2.18, 95% confidence interval [CI] 1.0-2.5, p <0.0001), cardiogenic shock (aOR 1.22, 95% CI 1.07 to 1.39, p = 0.0019), permanent pacemaker implantation (aOR 1.14, 95% CI 1.06 to 1.23, p = 0.0006), acute kidney injury (aOR 1.19, 95% CI 1.13 to 1.27, p <0.0001), sudden cardiac arrest (aOR 1.32, 95% CI 1.09 to 1.61, p = 0.004), major bleeding (aOR 1.1, 95% CI 1.006 to 1.22, p <0.0368) and higher rates of blood transfusion (aOR 1.62, 95% CI 1.5 to 1.75, p <0.0001) when compared with the TAVI CKD-LG cohort. However, there was no statistically significant difference in the odds of cerebrovascular accident and mechanical circulatory support use between the 2 groups.
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Affiliation(s)
- David Song
- Department of Internal Medicine, Icahn school of Medicine at Mount Sinai Elmhurst Hospital, Queens, New York
| | - Yasar Sattar
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia
| | - Mohammed Faisaluddin
- Deparmtent of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Usama Talib
- Deparmtent of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky
| | - Neel Patel
- Deparmtent of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, Rhode Island
| | - Izza Shahid
- Deparmtent of Internal Medicine, Dow Medical College, Karachi, Pakistan
| | - Amro Taha
- Deparmtent of Internal Medicine, Weiss Memorial Hospital, Chicago, Illinois
| | - Fnu Raheela
- Deparmtent of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Prasana Sengodon
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia
| | - Maria Riasat
- Deparmtent of Internal Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, Manhattan, New York
| | - Vaibhav Shah
- Department of Internal Medicine, Icahn school of Medicine at Mount Sinai Elmhurst Hospital, Queens, New York
| | - Karthik Gonuguntla
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia
| | - Mahboob Alam
- Department of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas
| | - Islam Elgendy
- Deparmtent of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky
| | - Ramesh Daggubati
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia
| | - M Chadi Alraies
- Department of Cardiovascular Medicine, Detroit Medical Center, Detroit, Michigan.
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Lorente-Ros M, Das S, Malik A, Romeo FJ, Aguilar-Gallardo JS, Fakhoury M, Patel A. In-hospital outcomes of transcatheter aortic valve replacement in patients with chronic and end-stage renal disease: a nationwide database study. BMC Cardiovasc Disord 2024; 24:21. [PMID: 38172786 PMCID: PMC10765730 DOI: 10.1186/s12872-023-03684-z] [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: 05/28/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been associated with worse outcomes after transcatheter aortic valve replacement (TAVR). With TAVR indications extending to a wider range of patient populations, it is important to understand the current implications of chronic renal insufficiency on clinical outcomes. We aim to determine the impact of CKD and ESRD on in-hospital outcomes after TAVR. METHODS We queried the National Inpatient Sample for TAVR performed between 2016 and 2020 using International Classification of Diseases-10th Revision codes. We compared in-hospital mortality and clinical outcomes between three groups: normal renal function, CKD and ESRD. The association between CKD/ESRD and outcomes was tested with multivariable logistic regression analyses, using normal renal function as baseline. RESULTS In the five-year study period, 279,195 patients underwent TAVR (mean age 78.9 ± 8.5 years, 44.4% female). Of all patients, 67.1% had normal renal function, 29.2% had CKD, and 3.7% had ESRD. There were significant differences in age, sex, and prevalence of comorbidities across groups. In-hospital mortality was 1.3%. Compared to patients with normal renal function, patients with renal insufficiency had higher in-hospital mortality, with the highest risk found in patients with ESRD (adjusted odds ratio: 1.4 [95% confidence interval: 1.2-1.7] for CKD; adjusted odds ratio: 2.4 [95% confidence interval: 1.8-3.3] for ESRD). Patients with CKD or ESRD had a higher risk of cardiogenic shock, need for mechanical circulatory support, and vascular access complications, compared to those with normal renal function. In addition, patients with ESRD had a higher risk of cardiac arrest and periprocedural acute myocardial infarction. The incidence of conversion to open heart surgery was 0.3% and did not differ between groups. Post-procedural infectious and respiratory complications were more common among patients with CKD or ESRD. CONCLUSION Patients with CKD and ESRD are at higher risk of in-hospital mortality, cardiovascular, and non-cardiovascular complications after TAVR. The risk of complications is highest in patients with ESRD and does not result in more frequent conversion to open heart surgery. These results emphasize the importance of individualized patient selection for TAVR and procedural planning among patients with chronic renal insufficiency.
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Affiliation(s)
- Marta Lorente-Ros
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside Hospital, New York, NY, USA.
| | - Subrat Das
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Aaqib Malik
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Francisco Jose Romeo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside Hospital, New York, NY, USA
| | - Jose S Aguilar-Gallardo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside Hospital, New York, NY, USA
| | - Maya Fakhoury
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside Hospital, New York, NY, USA
| | - Amisha Patel
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside Hospital, New York, NY, USA
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Geißer D, Hetzel L, Westenfeld R, Boege F. Questionable Validity of Creatinine-Based eGFR in Elderly Patients but Cystatin C Is Helpful in First-Line Diagnostics. Geriatrics (Basel) 2023; 8:120. [PMID: 38132491 PMCID: PMC10742602 DOI: 10.3390/geriatrics8060120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The recommended chronic kidney disease (CKD) first-line diagnostic test is based on the creatinine-derived (estimated) glomerular filtration rate (eGFR). Cystatin C use may provide a better assessment. METHODS We compared creatinine- and cystatin C-derived eGFR determination as the first-line diagnostic test for 112 hospital patients aged > 60 years (median = 76 years). The patients were judged to not have CKD (no-CKD group) according to the first-line diagnostic recommendations (n = 61, eGFR (CKD Epidemiology Collaboration (CKD-EPI)) ≥ 60 mL/min/1.73 m2, total urine protein < 150 mg/g creatinine, urinary red/white blood cells not increased) or classified to be at risk for kidney insufficiency due to aortic valve dysfunction (at-risk group; n = 51). The accuracy of the eGFR values was evaluated retrospectively with the final case diagnoses. RESULTS The eGFR (Caucasian, Asian, pediatric, and adult formula (CAPA)) was found to be linearly correlated to the eGFR (CKD-EPI) (R2 = 0.5, slope = 0.69, p < 0.0001). In 93/112 (>80%) cases, the eGFR (CAPA) yielded lower values (on average ≈-20%). In 55/112 (49%) cases, the cystatin C-derived CKD stage was lower. CKD reclassification from no-CKD to a kidney-insufficient state (i.e., CKD1/2 to CKD3a/b or 4) or reclassification to a more severe kidney insufficiency (i.e., CKD3a → 3b/4 or 3b → 4) was found in 41/112 (37%) cases. A worse CKD classification (no-CKD → kidney-insufficient) based on the eGFR (CAPA) was plausible in 30% of cases in light of the final case diagnoses. CONCLUSION In elderly patients (>60 years), renal function appears to be systematically overestimated by the creatinine-based eGFR (CKD-EPI), indicating that, for this group, the cystatin C-based eGFR (CAPA) should be used as the first-line diagnostic test.
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Affiliation(s)
- Dario Geißer
- Central Institute of Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, Heinrich Heine University and University Hospital, 40225 Düsseldorf, Germany;
| | - Lina Hetzel
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, Germany; (L.H.); (R.W.)
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, Germany; (L.H.); (R.W.)
| | - Fritz Boege
- Central Institute of Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, Heinrich Heine University and University Hospital, 40225 Düsseldorf, Germany;
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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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de Terwangne C, Maes F, Gilard I, Kefer J, Cornette P, Boland B. OLD-TAVR score to predict 2-year mortality in patients aged 75 years and more undergoing transcatheter aortic valve replacement. Eur Geriatr Med 2023:10.1007/s41999-023-00794-x. [PMID: 37165292 DOI: 10.1007/s41999-023-00794-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Decision-making on transcatheter aortic valve replacement (TAVR) in patients aged 75 years and older is complex. It could be facilitated by the identification of predictors of long-term mortality. This study aimed to identify predictors of 2-year mortality to develop a 2-year mortality risk score. METHODS Cohort study of consecutive patients aged ≥ 75 years who underwent TAVR after a comprehensive geriatric assessment (CGA) at our university hospital between 2012 and 2019. Predictors of 2-year mortality were determined using multivariable Cox regression. A point-based predictive model was developed based on risk factors and subsequently internally validated by fivefold cross-validation. RESULTS The 345 patients (median age 87 years, 54% women) were fit/vulnerable (32%), mildly frail (37%), or moderately/severely frail (31%). The overall 2-year mortality rate was 26%, predicted by atrial fibrillation, hemoglobin ≤ 10 g/dL, age ≥ 87 years, BMI ≤ 24, eGFR ≤ 50 ml/min, and moderate/severe frailty. The risk score (range 0-12), named OLD-TAVR score, for 2-year mortality showed good discriminative power (AUC 0.70) and remained consistent after fivefold cross-validation (cvAUC 0.69). A risk score ≥ 8 (prevalence 20%) predicted a 45% (95%CI: 34-58%) two-year mortality, with high specificity (86%) and good positive predictive power (+ LR 2.43). CONCLUSION A 2-year mortality risk score (OLD-TAVR score) for very old patients undergoing TAVR was developed based on six bio-clinical items. A score ≥ 8 identified patients in whom 2-year mortality was very high and thereby the TAVR futile. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION Study protocol B403, 26/09/2022, retrospectively registered.
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Affiliation(s)
- Christophe de Terwangne
- Geriatric Medicine, Cliniques Universitaires Saint-Luc - Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Frédéric Maes
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Isabelle Gilard
- Geriatric Medicine, Cliniques Universitaires Saint-Luc - Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Joëlle Kefer
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Pascale Cornette
- Geriatric Medicine, Cliniques Universitaires Saint-Luc - Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Institute of Health and Society (IRSS), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Benoit Boland
- Geriatric Medicine, Cliniques Universitaires Saint-Luc - Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Institute of Health and Society (IRSS), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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Liao YC, Chang CC, Chen CY, Liu CC, Liao CC, Shih YRV, Lin CS. Preoperative renal insufficiency predicts postoperative adverse outcomes in a mixed surgical population: a retrospective matched cohort study using the NSQIP database. Int J Surg 2023; 109:752-759. [PMID: 36974714 PMCID: PMC10389524 DOI: 10.1097/js9.0000000000000278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/27/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The incidence of chronic kidney disease is increasing, but most cases are not diagnosed until the accidental finding of abnormal laboratory data or the presentation of severe symptoms. Patients with chronic kidney disease are reported to have an increased risk of postoperative mortality and morbidities, but previous studies mainly targeted populations undergoing cardiovascular surgery. The authors aimed to evaluate the risk of postoperative mortality and complications in a surgical population with preoperative renal insufficiency (RI). MATERIALS AND METHODS This retrospective cohort study used data from the National Surgical Quality Improvement Program database between 2013 and 2018 to evaluate the risk of postoperative morbidity and mortality in the surgical population. Patients with estimated glomerular filtration rate less than 60 ml/min/1.73 m 2 were defined as the RI group. Propensity score matching methods and multivariate logistic regression were used to calculate the risk of postoperative morbidity and mortality. RESULTS After propensity score matching, 502 281 patients were included in the RI and non-RI groups. The RI group had a higher risk of 30-day in-hospital mortality (odds ratio: 1.54, 95% CI: 1.49-1.58) than the non-RI group. The RI group was associated with a higher risk of postoperative complications, including myocardial infarction, stroke, pneumonia, septic shock, and postoperative bleeding. The RI group was also associated with an increased risk of prolonged ventilator use for over 48 h, readmission, and reoperation. CONCLUSION Patients with preoperative RI have an increased risk of postoperative 30-day mortality and complications. RI group patients with current dialysis, estimated glomerular filtration rate less than or equal to 30 ml/min/1.73 m 2 or concomitant anemia had an elevated risk of postoperative mortality.
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Affiliation(s)
| | - Chuen-Chau Chang
- Department of Anesthesiology
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Chen
- Department of Anesthesiology
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chung Liu
- Department of Anesthesiology
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ru Vernon Shih
- Department of Orthopedic Surgery, Duke University, Durham, North Carolina, USA
| | - Chao-Shun Lin
- Department of Anesthesiology
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Rivera FB, Cu MVV, Cua SJ, De Luna DV, Lerma EV, McCullough PA, Kazory A, Collado FMS. Aortic Stenosis and Aortic Valve Replacement among Patients with Chronic Kidney Disease: A Narrative Review. Cardiorenal Med 2023; 13:74-90. [PMID: 36812906 DOI: 10.1159/000529543] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Aortic stenosis (AS) can present with dyspnea, angina, syncope, and palpitations, and this presents a diagnostic challenge as chronic kidney disease (CKD) and other commonly found comorbid conditions may present similarly. While medical optimization is an important aspect in management, aortic valve replacement (AVR) by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) is the definitive treatment. Patients with concomitant CKD and AS require special consideration as it is known that CKD is associated with progression of AS and poor long-term outcomes. AIMS AND OBJECTIVES The aim of the study was to summarize and review the current existing literature on patients with both CKD and AS regarding disease progression, dialysis methods, surgical intervention, and postoperative outcomes. CONCLUSION The incidence of AS increases with age but has also been independently associated with CKD and furthermore with hemodialysis (HD). Regular dialysis with HD versus peritoneal dialysis (PD) and female gender have been associated with progression of AS. Management of AS is multidisciplinary and requires planning and interventions by the heart-kidney team to decrease the risk of further inducing kidney injury among high-risk population. Both TAVR and SAVR are effective interventions for patients with severe symptomatic AS, but TAVR has been associated with better short-term renal and cardiovascular outcomes. IMPLICATIONS FOR PRACTICE Special consideration must be given to patients with both CKD and AS. The choice of whether to undergo HD versus PD among patients with CKD is multifactorial, but studies have shown benefit regarding AS progression among those who undergo PD. The choice regarding AVR approach is likewise the same. TAVR has been associated with decreased complications among CKD patients, but the decision is multifactorial and requires a comprehensive discussion with the heart-kidney team as many other factors play a role in the decision including preference, prognosis, and other risk factors.
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Affiliation(s)
| | | | | | | | - Edgar V Lerma
- Section of Nephrology, University of Illinois at Chicago College of Medicine/ Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | | | - Amir Kazory
- Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida, USA
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Kure Y, Okai T, Izumiya Y, Yoshida H, Mizutani K, Yamaguchi T, Ogawa M, Shibata A, Ito A, Takahashi Y, Shibata T, Fukuda D. Impact of cystatin C-derived glomerular filtration rate in patients undergoing transcatheter aortic valve implantation. Front Cardiovasc Med 2023; 10:1035736. [PMID: 37187794 PMCID: PMC10176087 DOI: 10.3389/fcvm.2023.1035736] [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: 09/03/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Abstract
Background Chronic kidney disease (CKD) impacts prognosis in patients undergoing transcatheter aortic valve implantation (TAVI). While estimated glomerular filtration rate (eGFR) calculated from serum creatinine [eGFR (creatinine)] is affected by body muscle mass which reflects frailty, eGFR calculated from serum cystatin C [eGFR (cystatin C)] is independent of body composition, resulting in better renal function assessment. Methods This study included 390 consecutive patients with symptomatic severe aortic stenosis (AS) who underwent TAVI, and measured cystatin C-based eGFR at discharge. Patients were divided into two groups, with or without CKD estimated with eGFR (cystatin C). The primary endpoint of this study was the 3-year all-cause mortality after TAVI. Results The median patient age was 84 years, and 32.8% patients were men. Multivariate Cox regression analysis indicated that eGFR (cystatin C), diabetes mellitus, and liver disease were independently associated with 3-year all-cause mortality. In the receiver-operating characteristic (ROC) curve, the predictive value of eGFR (cystatin C) was significantly higher than that of eGFR (creatinine). Furthermore, Kaplan-Meier estimates revealed that 3-year all-cause mortality was higher in the CKD (cystatin C) group than that in the non-CKD (cystatin C) group with log-rank p = 0.009. In contrast, there was no significant difference between the CKD (creatinine) and non-CKD (creatinine) groups with log-rank p = 0.94. Conclusions eGFR (cystatin C) was associated with 3-year all-cause mortality in patients who underwent TAVI, and it was superior to eGFR (creatinine) as a prognostic biomarker.
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Affiliation(s)
- Yusuke Kure
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Tsukasa Okai
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Correspondence: Tsukasa Okai
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hisako Yoshida
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kazuki Mizutani
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tomohiro Yamaguchi
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Mana Ogawa
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Shibata
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Asahiro Ito
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Haseeb ul Rasool M, Saleem M, Nadeem M, Maqbool M, Aziz AA, Fox JM, Suleiman A. The Role of Transcatheter Aortic Valve Replacement in Asymptomatic Aortic Stenosis: A Feasibility Analysis. Cureus 2022; 14:e29522. [PMID: 36312695 PMCID: PMC9589522 DOI: 10.7759/cureus.29522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 11/26/2022] Open
Abstract
Surgical aortic valve replacement (SAVR) is the current treatment of choice for good surgical candidates with moderate to severe symptomatic aortic stenosis (AS). As transcatheter aortic valvular replacement (TAVR) has shown an improved one and two-year all-cause mortality, it has been chosen for moderately symptomatic severe AS patients. The purpose of this review was to perform a clinical comparison of TAVR vs. SAVR and to analyze the Health Index Factor (HIF) that makes TAVR a treatment of choice in asymptomatic AS patients. An extensive literature search of PubMed, Cochrane, and Embase databases was performed using the keywords “Aortic stenosis”, “SAVR”, “TAVR”, and “Asymptomatic”. A total of 45 prospective randomized clinical trials in the English language that were published from the year 2000 onwards were included in the final analysis. It has been found that 59.3% of asymptomatic AS patients are likely to die in the next five years without proactive treatment. Multiple studies have proven that early intervention with aortic valve replacement is superior to conservative treatment in severe asymptomatic AS; however, the choice between SAVR and TAVR is not well established. The NOTION Trial, SURTAVI Trail, and PARTNER 3 study have shown the non-inferiority of TAVR over SAVR, during one-year follow-up for low surgical risk patients. Evolut Low-Risk study and Early TAVR are the only two prospective studies performed to date that have enrolled patients with asymptomatic severe AS. The Evolut Trial demonstrated no difference in all-cause mortality at 30 days (1.3% vs. 4.8%. p=0.23), and 12 days (1.3% vs. 6.5%, p=0.11). Additionally, TAVR also decreases the risk of post-procedural atrial fibrillation, acute kidney injury (AKI), and rehospitalization, and leads to significant improvement in the mean trans-aortic pressure gradient. TAVR also showed marked improvement in the 30-day Quality of Life (QOL) index, where SAVR did not report any significant change in the QOL index. However, the official recommendations of Early TAVR are still awaited. TAVR has consistently shown a statistically non-significant difference in case mortality, risk of stroke, and rehospitalization with moderate to high surgical risk patients whereby recent initial trials have shown significant improvement in the QOL index and hemodynamic index for patients with asymptomatic disease. More extensive studies are required to prove the risk stratifications, long-term outcomes, and clinical characteristics that would make TAVR a preferred intervention in asymptomatic patients.
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13
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Tan ECH, Lee YT, Kuo YC, Tsao TP, Lee KC, Hsiung MC, Wei J, Lin KC, Yin WH. Clinical outcomes and cumulative healthcare costs of TAVR vs. SAVR in Asia. Front Cardiovasc Med 2022; 9:973889. [PMID: 36211540 PMCID: PMC9532629 DOI: 10.3389/fcvm.2022.973889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives This study compared transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in terms of short- and long-term effectiveness. Methods This retrospective cohort study based on nationwide National Health Insurance claims data and Cause of Death data focused on adult patients (n = 3,643) who received SAVR (79%) or TAVR (21%) between 2015 and 2019. Propensity score overlap weighting was applied to account for selection bias. Primary outcomes included all-cause mortality (ACM), hospitalization for heart failure, and a composite endpoint of major adverse cardiac events (MACE). Secondary outcomes included medical utilization, hospital stay, and total medical costs at index admission for the procedure and in various post-procedure periods. The Cox proportional-hazard model with competing risk was used to investigate survival and incidental health outcomes. Generalized estimation equation (GEE) models were used to estimate differences in the utilization of medical resources and overall costs. Results After weighting, the mean age of the patients was 77.98 ± 5.86 years in the TAVR group and 77.98 ± 2.55 years in the SAVR group. More than half of the patients were female (53.94%). The incidence of negative outcomes was lower in the TAVR group than in the SAVR group, including 1-year ACM (11.39 vs. 17.98%) and 3-year ACM (15.77 vs. 23.85%). The risk of ACM was lower in the TAVR group (HR [95% CI]: 0.61 [0.44–0.84]; P = 0.002) as was the risk of CV death (HR [95% CI]: 0.47 [0.30–0.74]; P = 0.001) or MACE (HR [95% CI]: 0.66 [0.46–0.96]; P = 0.0274). Total medical costs were significantly higher in the TAVR group than in the SAVR in the first year after the procedure ($1,271.89 ± 4,048.36 vs. $887.20 ± 978.51; P = 0.0266); however, costs were similar in the second and third years after the procedure. The cumulative total medical costs after the procedure were significantly higher in the TAVR group than in the SAVR group (adjusted difference: $420.49 ± 176.48; P = 0.0172). Conclusion In this real-world cohort of patients with aortic stenosis, TAVR proved superior to SAVR in terms of clinical outcomes and survival with comparable medical utilization after the procedure.
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Affiliation(s)
- Elise Chia-Hui Tan
- Department of Health Service Administration, China Medical University, Taichung, Taiwan
- Department of Pharmacy, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yu Chen Kuo
- Department of Health Service Administration, China Medical University, Taichung, Taiwan
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Chen Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | | | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Kuan-Chia Lin
- Community Research Center, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Kuan-Chia Lin
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Wei-Hsian Yin
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14
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Ooms JF, Cornelis K, Stella PR, Rensing BJ, Van Der Heyden J, Chan AW, Wykrzykowska JJ, Rosseel L, Vandeloo B, Lenzen MJ, Cunnington MS, Hildick-Smith D, Wijeysundera HC, Van Mieghem NM. Rationale and design of the Project to look for early discharge in patients undergoing TAVR with ACURATE (POLESTAR Trial). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 44:71-77. [PMID: 35739011 DOI: 10.1016/j.carrev.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/11/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is now an established treatment strategy for elderly patients with symptomatic aortic stenosis (AS) across the entire operative risk spectrum. Streamlined TAVR protocols along with reduced procedure time and expedited ambulation promote early hospital discharge. Selection of patients suitable for safe early discharge after TAVR might improve healthcare efficiency. STUDY DESIGN The POLESTAR trial is an international, multi-center, prospective, observational study which aims to evaluate the safety of early discharge in selected patients who undergo TAVR with the supra-annular functioning self-expanding ACURATE Neo transcatheter heart valve (THV). A total of 250 patients will be included based on a set of baseline criteria indicating potential early discharge (within 48 h post-TAVR). Primary study endpoints include Valve Academic Research Consortium (VARC)-3 defined safety at 30 days and VARC-3 defined efficacy at 30 days and 1 year. Endpoints will be compared between early discharge and non-early discharge cohorts with a distinct landmark analysis at 48 h post-TAVR. Secondary endpoints include quality of life assessed using EQ5D-5L and Kansas City Cardiomyopathy Questionnaire (KCCQ) questionnaires and resource costs compared between discharge groups. SUMMARY The POLESTAR trial prospectively evaluates safety and feasibility of an early discharge protocol for TAVR using the ACURATE Neo THV.
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Affiliation(s)
- Joris F Ooms
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | | | - Albert W Chan
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | | | | | - Mattie J Lenzen
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - David Hildick-Smith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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15
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Kuwabara K, Zen K, Yashige M, Takamatsu K, Ito N, Kadoya Y, Yamano M, Yamano T, Nakamura T, Yaku H, Matoba S. Cystatin C in risk prediction after transcatheter aortic valve replacement: a retrospective analysis. ESC Heart Fail 2022; 9:2601-2609. [PMID: 35661440 PMCID: PMC9288764 DOI: 10.1002/ehf2.13977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/31/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Aims No study has evaluated the prognostic value of the chronic kidney disease (CKD) classification by cystatin C‐based estimated glomerular filtration rate (eGFR) (CKDCys classification) in patients undergoing transcatheter aortic valve replacement (TAVR). This study aimed to compare the prognostic value of CKDCys classification and CKD classification by creatinine‐based eGFR (CKDCr classification) in risk prediction after TAVR. Methods and results We retrospectively analysed consecutive 219 patients with symptomatic severe aortic stenosis who underwent TAVR at our institute between December 2016 and June 2019. Pre‐operative CKDCr and CKDCys classifications were evaluated for their prognostic value of 2‐year major adverse cardiovascular and cerebrovascular events (MACCE) after TAVR. MACCE was defined as the composite of all‐cause mortality, non‐fatal myocardial infarction, stroke, and rehospitalization for worsening congestive heart failure. Participants had a median age of 86.0 years and were predominantly female (76.9%). In 96.6% of the cases, TAVR was performed using transfemoral access. The median creatinine‐based eGFR (52.85 mL/min/1.73 m2) was higher than the cystatin C‐based eGFR (41.50 mL/min/1.73 m2). Downward reclassification in CKD stages based on eGFRCys was observed in 49.0% of patients. During a median follow‐up period of 575.5 (interquartile range: 367.0–730.0) days, 58 patients presented with MACCE. CKDCys classification, but not CKDCr classification, significantly stratified the risk of 2‐year MACCE in patients after TAVR by log‐rank test (P = 0.003). In multivariate Cox regression analysis, only CKDCys stage 3b [hazard ratio (HR) = 4.37; 95% confidence interval (CI): 1.28–14.91; P = 0.019] and CKDCys stage 4 + 5 (HR = 3.72; 95% CI: 1.06–12.99; P = 0.040) were significant predictors of MACCE after adjustment for potential confounders. Conclusions The CKDCys classification could better assess the risk than the CKDCr classification in patients undergoing TAVR. CKDCys stage 3b and stage 4 + 5 correlated with adverse outcomes.
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Affiliation(s)
- Kensuke Kuwabara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan.,Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaki Yashige
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuaki Takamatsu
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobuyasu Ito
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Kadoya
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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16
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Patel RV, Ravindran M, Manoragavan R, Sriharan A, Wijeysundera HC. Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review. CJC Open 2022; 4:792-801. [PMID: 36148255 PMCID: PMC9486870 DOI: 10.1016/j.cjco.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Despite transcatheter aortic valve implantation (TAVI) becoming a widely accepted therapeutic option for the management of aortic stenosis, post-procedure readmission rates remain high. Rehospitalization is associated with negative patient outcomes, as well as increased healthcare costs, and has therefore been identified as an important target for quality improvement. Strategies to reduce the post-TAVI readmission rate are needed but require the identification of patients at high risk for rehospitalization. Our systematic review aims to identify predictors of post-procedure readmission in patients eligible for TAVI. Methods We conducted a comprehensive search of the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for the time period from 2015 to the present for articles evaluating risk factors for rehospitalization post-TAVI with a follow-up period of at least 30 days in adults age ≥ 70 years with aortic stenosis. The quality of included studies was evaluated using the Newcastle-Ottawa Scale. We present the results as a qualitative narrative review. Results We identified 49 studies involving 828,528 patients. Post-TAVI readmission is frequent, and rates vary (14.9% to 54.3% at 1 year). The most-frequent predictors identified for both 30-day and 1-year post-TAVI readmission are atrial fibrillation, lung disease, renal disease, diabetes mellitus, in-hospital life-threatening bleeding, and non-femoral access. Conclusions This systematic review identifies the most-common predictors for 30-day and 1-year readmission post-TAVI, including comorbidities and potentially modifiable procedural approaches and complications. These predictors can be used to identify patients at high-risk for readmission who are most likely to benefit from increased support and follow-up post-TAVI.
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17
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Ikuta A, Ohya M, Kubo S, Osakada K, Takamatsu M, Takahashi K, Maruo T, Katoh H, Matsuo T, Nakano J, Kadota K, Komiya T, Fuku Y. Renal cortex thickness and changes in renal function after transcatheter aortic valve implantation. EUROINTERVENTION 2022; 17:e1407-e1416. [PMID: 34726600 PMCID: PMC9896392 DOI: 10.4244/eij-d-21-00534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The association between renal morphological findings and changes in renal function in patients undergoing transcatheter aortic valve implantation (TAVI) is unexplored. AIMS We aimed to investigate the association between renal morphological findings and changes in renal function in patients undergoing TAVI. METHODS Among 283 consecutive patients undergoing TAVI between 2018 and 2021, the study sample included 224 patients. Renal morphological measurements were performed by preoperative multidetector computed tomography. Estimated glomerular filtration rate (eGFR) improvement and deterioration were defined as positive or negative changes in an eGFR of ≥10% one month after TAVI. The renal cortex thickness index was defined as the ratio of total renal cortex thickness to body surface area. RESULTS The incidences of eGFR improvement and deterioration were 33.9% and 24.1%, respectively. The renal cortex thickness index had a significant correlation with changes in eGFR (r=0.34, p<0.01). The index of the area under the curve of renal cortex thickness for eGFR improvement and deterioration were 0.73 and 0.68, respectively. The cut-off values were 5.82 mm/m2 for eGFR improvement (odds ratio [OR]: 0.10; 95% confidence interval: 0.05-0.20; p<0.01) and 4.89 mm/m2 for eGFR deterioration (OR: 9.07; 95% confidence interval: 4.55-18.6; p<0.01). CONCLUSIONS The renal cortex thickness index was associated with changes in renal function in patients who underwent TAVI. Its measurements might be useful for predicting the renal function change in patients undergoing TAVI.
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Affiliation(s)
- Akihiro Ikuta
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masanobu Ohya
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602 Japan
| | - Shunsuke Kubo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kohei Osakada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Makoto Takamatsu
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kotaro Takahashi
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Maruo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Harumi Katoh
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takehiko Matsuo
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Jota Nakano
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
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18
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Clinical outcomes of patients with hepatic insufficiency undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. BMC Cardiovasc Disord 2022; 22:67. [PMID: 35196988 PMCID: PMC8864911 DOI: 10.1186/s12872-022-02510-2] [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: 06/07/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is currently a common treatment in high-risk aortic stenosis patients, but the impact of hepatic insufficiency on prognosis after TAVI is debatable and whether TAVI is superior to surgical aortic valve replacement (SAVR) in patients with hepatic insufficiency is uncertain. Objective To investigate the effect of abnormal liver function on the outcome and safety after TAVI and whether TAVI is superior to SAVR in patients with hepatic insufficiency. Methods PubMed, Embase, the Cochrane Library and Web of Science were systematically searched from inception up to 26 November 2021. Studies were eligible if mortality and complications after TAVI in patients with and without hepatic insufficiency, or mortality and complications for TAVI versus SAVR in patients with hepatic insufficiency were reported. The Newcastle–Ottawa scale (NOS) was used to evaluate the quality of each study. This meta-analysis was registered with PROSPERO (CRD42021253423) and was carried out by using RevMan 5.3 and Stata 14.0. Results This meta-analysis of 21 studies assessed a total of 222,694 patients. Hepatic insufficiency was associated with higher short-term (in-hospital or 30-day) mortality [OR = 1.62, 95% CI (1.18 to 2.21), P = 0.003] and 1–2 years mortality [HR = 1.64, 95% CI (1.42 to 1.89), P < 0.00001] after TAVI. Between TAVI and SAVR in patients with hepatic insufficiency, there was a statistically significant difference in in-hospital mortality [OR = 0.46, 95% CI (0.27 to 0.81), P = 0.007], the occurrence rate of blood transfusions [OR = 0.29, 95% CI (0.22 to 0.38), P < 0.00001] and the occurrence rate of acute kidney injury [OR = 0.55, 95% CI (0.33 to 0.91), P = 0.02]. Conclusions TAVI patients with hepatic insufficiency may have negative impact both on short-term (in-hospital or 30-day) and 1–2-years mortality. For patients with hepatic insufficiency, TAVI could be a better option than SAVR. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02510-2.
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Wang J, Liu S, Han X, Chen Y, Chen H, Dong S, Song B. Impact of Chronic Kidney Disease on the Prognosis of Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis: a Meta-Analysis of 133624 Patients. Ann Thorac Cardiovasc Surg 2021; 28:83-95. [PMID: 34897184 PMCID: PMC9081462 DOI: 10.5761/atcs.ra.21-00187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: The impact of chronic kidney disease (CKD) on the prognosis of transcatheter aortic valve replacement (TAVR) remains unclear. The purpose of this meta-analysis was to assess the impact of CKD and different stages of CKD on prognosis in patients undergoing TAVR. Methods: As of June 2020, we performed a comprehensive literature search on relevant studies using PubMed, Embase, Cochrane Library, and Web of Science. Subsequently, we pooled the risk ratio (RR) of individual studies via random effects to analyze heterogeneity, quality assessment, and publication bias. Results: A total of 20 studies, involving 133624 patients, were eligible for analysis. Patients with CKD had higher all-cause mortality at 30 days (RR: 1.39, 95% confidence interval [CI]: 1.31–1.47, P <0.001), 1 year (RR: 1.36, 95% CI: 1.24–1.49, P <0.001), and 2 years (RR: 1.2, 95% CI: 1.05–1.38, P = 0.009) of follow-up. Moreover, they also had higher acute kidney injury (AKI) (RR: 1.38, 95% CI: 1.16–1.63, P <0.001) and bleeding (RR: 1.33, 95% CI: 1.18–1.50, P <0.001) at 30 days. CKD3 alone also increased all-cause mortality at follow-ups. Risk of all-cause mortality increased with severity of CKD for stages 3, 4, and 5 at follow-up. Conclusion: Patients with CKD are at an increased risk of all-cause mortality, AKI, and bleeding events after TAVR. Moreover, the mortality risk rises with increasing severity of CKD.
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Affiliation(s)
- Jialu Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Shidong Liu
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Xiangxiang Han
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Yang Chen
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Hao Chen
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Shuai Dong
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Bing Song
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
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20
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Yoshijima N, Saito T, Inohara T, Anzai A, Tsuruta H, Shimizu H, Fukuda K, Naganuma T, Mizutani K, Yamawaki M, Tada N, Yamanaka F, Shirai S, Tabata M, Ueno H, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Predictors and clinical outcomes of poor symptomatic improvement after transcatheter aortic valve replacement. Open Heart 2021; 8:openhrt-2021-001742. [PMID: 34810275 PMCID: PMC8609939 DOI: 10.1136/openhrt-2021-001742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/08/2021] [Indexed: 02/05/2023] Open
Abstract
Objective Transcatheter aortic valve replacement (TAVR) improves clinical symptoms in most patients with severe aortic stenosis (AS). However, some patients do not benefit from the symptom-reducing effects of TAVR. We assessed the predictors and clinical outcomes of poor symptomatic improvement (SI) after TAVR. Methods A total of 1749 patients with severe symptomatic AS undergoing transfemoral TAVR were evaluated using the Japanese multicentre TAVR registry. Poor SI was defined as readmission for heart failure (HF) within 1 year after TAVR or New York Heart Association (NYHA) class ≥3 after 1 year. A logistic regression model was used to identify predictors of poor SI. One-year landmark analysis after TAVR was used to evaluate the association between poor SI and clinical outcomes. Results Among the overall population (mean age, 84.5 years; female, 71.3%; mean STS score, 6.3%), 6.6% were categorised as having poor SI. Atrial fibrillation, chronic obstructive pulmonary disease, Clinical Frailty Scale ≥4, chronic kidney disease and moderate to severe mitral regurgitation were independent predictors of poor SI. One-year landmark analysis demonstrated that poor SI had a higher incidence of all-cause death and readmission for HF compared with SI (p<0.001). Poor SI with preprocedural NYHA class 2 had a worse outcome than SI with preprocedural NYHA class ≥3. Conclusions Poor SI was associated with worse outcomes 1 year after the procedure. It had a greater impact on clinical outcomes than baseline symptoms. TAVR may be challenging for patients with many predictors of poor SI. Trial registration number This registry, associated with the University Hospital Medical Information Network Clinical Trials Registry, was accepted by the International Committee of Medical Journal Editors (UMIN-ID: 000020423).
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Affiliation(s)
- Nobuhiro Yoshijima
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Saito
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Anzai
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hikaru Tsuruta
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonankamakura General Hospital, Kamakura, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.,Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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21
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End-stage renal disease, calcification patterns and clinical outcomes after TAVI. Clin Res Cardiol 2021; 111:1313-1324. [PMID: 34773135 DOI: 10.1007/s00392-021-01968-y] [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: 08/08/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with chronic hemodialysis due to end-stage renal disease (ESRD) or severely impaired kidney function (CKD) constitute a relevant share of patients undergoing trans-catheter aortic valve implantation (TAVI). However, data on specific challenges and outcomes remain limited. AIM We aimed to characterize this patient population, evaluate clinical results and assess the significance of calcification patterns. METHODS This retrospective single-center analysis evaluated 2,712 TAVI procedures (2012-2019) according to baseline renal function: GFR < 30 ml/min/1.73m2 (CKD; n = 210), chronic hemodialysis (ESRD; n = 119) and control (CTRL; n = 2383). Valvular and vascular calcification patterns were assessed from contrast-enhanced multi-detector computed tomography. Outcomes were evaluated in accordance with the VARC-2 definitions. RESULTS Operative risk was higher in ESRD and CKD vs. CTRL (STS-score 8.4% and 7.6% vs. 3.9%, p < 0.001) and patients with ESRD had more severe vascular calcifications (49.1% vs. 33.9% and 29.0%, p < 0.01). Immediate procedural results were similar but non-procedure-related major/life-threatening bleeding was higher in ESRD and CKD (5.0% and 5.3% vs. 1.6%, p < 0.01). 3-year survival was impaired in patients with ESRD and CKD (33.3% and 35.3% vs. 65.4%, p < 0.001). Multivariable analysis identified ESRD (HR 1.60), CKD (HR 1.79) and vascular calcifications (HR 1.29) as predictors for 3-year and vascular calcifications (HR 1.51) for 30-day mortality. CONCLUSION Patients with ESRD and CKD constitute a vulnerable patient group with extensive vascular calcifications. Immediate procedural results were largely unaffected by renal impairment, yielding TAVI a particularly valuable treatment option in these high-risk operative patients. Mid-term survival was determined by underlying renal disease, cardiovascular comorbidities, and vascular calcifications as a novel risk marker.
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22
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Garcia S, Cubeddu RJ, Hahn RT, Ternacle J, Kapadia SR, Kodali SK, Thourani VH, Jaber WA, Asher CR, Elmariah S, Makkar R, Webb JG, Herrmann HC, Lu M, Devireddy CM, Malaisrie SC, Smith CR, Mack MJ, Sorajja P, Cavalcante JL, Goessl M, Shroff GR, Leon MB, Pibarot P. 5-Year Outcomes Comparing Surgical Versus Transcatheter Aortic Valve Replacement in Patients With Chronic Kidney Disease. JACC Cardiovasc Interv 2021; 14:1995-2005. [PMID: 34556273 DOI: 10.1016/j.jcin.2021.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/14/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to compare 5-year cardiovascular, renal, and bioprosthetic valve durability outcomes in patients with severe aortic stenosis (AS) and chronic kidney disease (CKD) undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). BACKGROUND Patients with severe AS and CKD undergoing TAVR or SAVR are a challenging, understudied clinical subset. METHODS Intermediate-risk patients with moderate to severe CKD (estimated glomerular filtration rate <60 mL/min/m2) from the PARTNER (Placement of Aortic Transcatheter Valve) 2A trial (patients randomly assigned to SAPIEN XT TAVR or SAVR) and SAPIEN 3 Intermediate Risk Registry were pooled. The composite primary outcome of death, stroke, rehospitalization, and new hemodialysis was evaluated using Cox regression analysis. Patients with and without perioperative acute kidney injury (AKI) were followed through 5 years. A core laboratory-adjudicated analysis of structural valve deterioration and bioprosthetic valve failure was also performed. RESULTS The study population included 1,045 TAVR patients (512 SAPIEN XT, 533 SAPIEN 3) and 479 SAVR patients. At 5 years, SAVR was better than SAPIEN XT TAVR (52.8% vs 68.0%; P = 0.04) but similar to SAPIEN 3 TAVR (52.8% vs 58.7%; P = 0.89). Perioperative AKI was more common after SAVR than TAVR (26.3% vs 10.3%; P < 0.001) and was independently associated with long-term outcomes. Compared with SAVR, bioprosthetic valve failure and stage 2 or 3 structural valve deterioration were significantly greater for SAPIEN XT TAVR (P < 0.05) but not for SAPIEN 3 TAVR. CONCLUSIONS In intermediate-risk patients with AS and CKD, SAPIEN 3 TAVR and SAVR were associated with a similar risk for the primary endpoint at 5 years. AKI was more common after SAVR than TAVR, and SAPIEN 3 valve durability was comparable with that of surgical bioprostheses.
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Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
| | | | - Rebecca T Hahn
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec, Québec, Canada
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart and Vascular Institute, Atlanta, Georgia, USA
| | - Wael A Jaber
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Craig R Asher
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Weston, Weston, Florida, USA
| | - Sammy Elmariah
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Howard C Herrmann
- Department of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Lu
- Edwards Lifesciences, Irvine, California, USA
| | - Chandan M Devireddy
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - S Chris Malaisrie
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Craig R Smith
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor Scott & White Health, Plano, Texas, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Mario Goessl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Gautam R Shroff
- Hennepin Healthcare and University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec, Québec, Canada
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23
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Wang J, Liu S, Han X, Wan Z, Chen Y, Chen H, Song B. Impact of chronic kidney disease on the prognosis of transcatheter aortic valve replacement in patients with aortic stenosis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26696. [PMID: 34398041 PMCID: PMC8294914 DOI: 10.1097/md.0000000000026696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The prognosis of patients with aortic stenosis, in conjunction with chronic kidney disease (CKD), after transcatheter aortic valve replacement (TAVR) remains unclear. This study assessed the impact of CKD, and different stages of CKD, on prognosis of patients undergoing TAVR. METHODS The protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement guidelines. As of June 2021, we performed a comprehensive literature search on studies related to CKD and TAVR, using databases such as PubMed, Embase, Cochrane Library, and Web of Science. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. Then, Stata 15.0 software was used for meta-analysis. RESULTS AND CONCLUSION The purpose of this study was to evaluate the effect of CKD and different stages of CKD on the prognosis of patients with TAVR. It is hoped to provide a comprehensive reference for clinical practice and related clinical trials in the future.
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Affiliation(s)
- Jialu Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Shidong Liu
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Xiangxiang Han
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Zunhui Wan
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Yang Chen
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Hao Chen
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Bing Song
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
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24
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Phan DQ, Lee MS, Aharonian V, Mansukhani P, Moore N, Brar SS, Zadegan R. Association between mid-term worsening renal function and mortality after transcatheter aortic valve replacement in patients with chronic kidney disease. Catheter Cardiovasc Interv 2021; 98:185-194. [PMID: 33336519 DOI: 10.1002/ccd.29429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/02/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD), acute kidney injury (AKI) and worsening renal function at 30 days after transcatheter aortic valve replacement (TAVR) portend poor outcomes. We sought to evaluate the association between worsening renal function at 3-6 months and mortality among patients with baseline renal dysfunction undergoing TAVR. METHODS This is a retrospective study of patients with glomerular filtration rate (GFR) < 60 ml/min undergoing TAVR between June 2011 and March 2019 at the Regional Cardiac Catheterization Lab at Kaiser Permanente Los Angeles. Worsening renal function at 3-6 months post-TAVR was defined as: increase in serum creatinine >1.5 times compared to baseline, absolute increase of ≥0.3 mg/dl, or initiation of dialysis. RESULTS Of 683 patients reviewed, 176 were included in the analysis (median age 84 [IQR 79-88] years, 56% female). Of these, 27 (15.3%) had worsening renal function. AKI post-TAVR (OR 2.9, 95% CI 1.1-7.4, p = .03) and transfusion of ≥4 units red blood cells (OR 8.4, 95% CI 1.2-59, p = .03) were independent predictors of worsening renal function. Worsening renal function increased risk for mortality (HR 2.2, 95% CI 1.17-4.27, p = .015) at a median follow-up of 691 days. Those with improved/stable function with baseline GFR < 60 ml/min had comparable mortality risk to those with baseline GFR ≥ 60 ml/min (18% vs. 16.5%; HR 1.1, 95% CI 0.72-1.75, p = .62). CONCLUSION Among patients with baseline renal dysfunction, only 15% developed worsening renal function at 3-6 months after TAVR, which was associated with increased mortality. Predictors for worsening renal function include AKI and blood transfusions. Preventative measures peri-procedurally and continued monitoring post-discharge are warranted to improve outcomes.
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Affiliation(s)
- Derek Q Phan
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Vicken Aharonian
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Prakash Mansukhani
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Naing Moore
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Somjot S Brar
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Ray Zadegan
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
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25
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Mas-Peiro S, Faerber G, Bon D, Herrmann E, Bauer T, Bleiziffer S, Bekeredjian R, Böning A, Frerker C, Beckmann A, Möllmann H, Vasa-Nicotera M, Ensminger S, Hamm CW, Beyersdorf F, Fichtlscherer S, Walther T. Impact of chronic kidney disease in 29 893 patients undergoing transcatheter or surgical aortic valve replacement from the German Aortic Valve Registry. Eur J Cardiothorac Surg 2021; 59:532-544. [PMID: 33454757 DOI: 10.1093/ejcts/ezaa446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Chronic kidney disease (CKD) is a key risk factor in patients undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). We analysed the impact of estimated glomerular filtration rate (eGFR) and CKD stages on their mid-term survival. METHODS Data from 29 893 patients enrolled in the German Aortic Valve registry from January 2011 to December 2015 receiving TAVI (n = 12 834) or SAVR (n = 17 059) at 88 sites were included. The impact of renal impairment, as measured by eGFR and CKD stages, was investigated. The primary end-point was 1-year cumulative all-cause mortality. RESULTS Higher CKD stages were significantly associated to lower in-hospital, 30-day- and 1-year survival rates. Both TAVI- and SAVR-treated patients in CKD 3a, 3b, 4 and 5 stages showed significant and gradually increasing HR values for 1-year all-cause mortality. The same trend persisted in multivariable analysis, although HR values for CKD 3a and 5 did not reach significance in TAVI patients, whereas CKD 4 + 5 did not reach statistical significance in SAVR. Likewise, eGFR as a continuous variable was a significant predictor for 1-year mortality, with the best cut-off points being 47.4 ml/min/1.73 m2 for TAVI and 59.8 ml/min/1.73 m2 for SAVR. Significant 8.6% and 9.0% increases in 1-year mortality were observed for every 5-ml reduction in eGFR for TAVI and SAVR, respectively. CONCLUSIONS CKD ≥3b and CKD ≥3a are the independent major risk factors for mortality in patients undergoing TAVI and SAVR, respectively. In the overall population of patients with severe aortic stenosis, an appropriate stratification based on CKD substage may contribute to a better selection of patients suitable for such therapies.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Rhine-Main, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Dimitra Bon
- German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Rhine-Main, Germany.,Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Eva Herrmann
- German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Rhine-Main, Germany.,Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Timm Bauer
- Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Sabine Bleiziffer
- Department of Cardiothoracic Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | | | - Andreas Böning
- Department of Cardiothoracic Surgery, University Hospital Giessen, Giessen, Germany
| | - Christian Frerker
- Department of Internal Medicine III, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andreas Beckmann
- German Society of Thoracic and Cardiovascular Surgery, Langenbeck-Virchow-Haus, Berlin, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Rhine-Main, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Christian W Hamm
- German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Rhine-Main, Germany.,Department of Cardiology Kerckhoff Campus, University of Giessen, Giessen, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg - Bad Krozingen, University Hospital Freiburg, Freiburg, Germany.,Medical Faculty of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Rhine-Main, Germany
| | - Thomas Walther
- German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Rhine-Main, Germany.,Department of Cardiothoracic Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
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26
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Shroff GR, Bangalore S, Bhave NM, Chang TI, Garcia S, Mathew RO, Rangaswami J, Ternacle J, Thourani VH, Pibarot P. Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e1088-e1114. [PMID: 33980041 DOI: 10.1161/cir.0000000000000979] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortic stenosis with concomitant chronic kidney disease (CKD) represents a clinical challenge. Aortic stenosis is more prevalent and progresses more rapidly and unpredictably in CKD, and the presence of CKD is associated with worse short-term and long-term outcomes after aortic valve replacement. Because patients with advanced CKD and end-stage kidney disease have been excluded from randomized trials, clinicians need to make complex management decisions in this population that are based on retrospective and observational evidence. This statement summarizes the epidemiological and pathophysiological characteristics of aortic stenosis in the context of CKD, evaluates the nuances and prognostic information provided by noninvasive cardiovascular imaging with echocardiography and advanced imaging techniques, and outlines the special risks in this population. Furthermore, this statement provides a critical review of the existing literature pertaining to clinical outcomes of surgical versus transcatheter aortic valve replacement in this high-risk population to help guide clinical decision making in the choice of aortic valve replacement and specific prosthesis. Finally, this statement provides an approach to the perioperative management of these patients, with special attention to a multidisciplinary heart-kidney collaborative team-based approach.
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27
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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28
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Abushouk AI, Abdelfattah OM, Hassanein M, Saad AM, Vipparla N, Isogai T, Gad MM, Nakhoul G, Krishnaswamy A, Kapadia S. Transcatheter Aortic Valve Implantation Outcomes in Chronic Kidney Disease Versus End-Stage Kidney Disease. Am J Cardiol 2021; 143:165-167. [PMID: 33453172 DOI: 10.1016/j.amjcard.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Omar M Abdelfattah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Internal Medicine, Morristown Medical Center, Atlantic Health System, Morristown, New Jersey
| | - Mohamed Hassanein
- Department of Nephrology and Hypertension, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anas M Saad
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Navya Vipparla
- Internal Medicine Department, Central Michigan University, Saginaw, Michigan
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed M Gad
- Internal Medicine Department, Cleveland Clinic, Cleveland, Ohio
| | - Georges Nakhoul
- Department of Nephrology and Hypertension, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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29
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 520] [Impact Index Per Article: 173.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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30
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 721] [Impact Index Per Article: 240.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Tang G, Lv Q, He X. Comparison of postoperative outcomes following multidetector computed tomography based vs transesophageal echocardiography based annulus sizing for transcatheter aortic valve replacement: A systematic review and meta-analysis. Echocardiography 2020; 37:1617-1626. [PMID: 32965702 PMCID: PMC7702059 DOI: 10.1111/echo.14684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this paper was to evaluate the difference in postoperative outcomes following multidetector computed tomography (MDCT) and transesophageal echocardiography (TEE)-based annulus sizing for transcatheter aortic valve replacement (TAVR). METHODS Electronic search of PubMed, Biomed Central, Scopus, and Google Scholar databases was conducted until August 15, 2019. We included all types of studies comparing MDCT-based annulus sizing with TEE-based annulus sizing and assessing paravalvular regurgitation (PVR). Data were summarized using the Mantel-Haenszel odds ratio (OR) with 95% confidence intervals (CI). RESULTS A total of six studies were included. Pooled analysis of 431 participants in the MDCT group and 509 participants in the TEE group demonstrated that MDCT-based annulus sizing is associated with a significantly lower incidence of more than moderate PVR as compared to 2DTEE-based sizing (OR: 0.31, 95% CI: 0.18-0.54, P < .0001; I2 = 0%). There was no statistical difference in annulus rupture (OR: 0.57, 95% CI: 0.12-2.66, P = .91; I2 = 0%), procedural mortality (OR: 0.97, 95% CI: 0.19-4.86, P = .97; I2 = 0%), and 30-day mortality (OR: 0.63, 95% CI: 0.26-1.50, P = .29; I2 = 0%) with MDCT or 2DTEE-based annulus sizing. Compared with 3DTEE, the incidence of PVR in the MDCT group was lower, but there was no statistical difference in 30-day mortality. CONCLUSION Use of MDCT in comparison with 2DTEE is associated with significantly lower incidence of more than moderate PVR after TAVR. There seems to be no difference in annulus rupture and 30-day mortality with either imaging modality.
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Affiliation(s)
- Guozhang Tang
- Department of EchocardiographyThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Qifeng Lv
- Department of EchocardiographyThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Xiangqin He
- Department of EchocardiographyThe Affiliated Hospital of Qingdao UniversityQingdaoChina
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Bohbot Y, Candellier A, Diouf M, Rusinaru D, Altes A, Pasquet A, Maréchaux S, Vanoverschelde JL, Tribouilloy C. Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement. J Am Heart Assoc 2020; 9:e017190. [PMID: 32964785 PMCID: PMC7792421 DOI: 10.1161/jaha.120.017190] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The prognostic significance of chronic kidney disease (CKD) in severe aortic stenosis is poorly understood and no studies have yet evaluated the effect of aortic‐valve replacement (AVR) versus conservative management on long‐term mortality by stage of CKD. Methods and Results We included 4119 patients with severe aortic stenosis. The population was divided into 4 groups according to the baseline estimated glomerular filtration rate: no CKD, mild CKD, moderate CKD, and severe CKD. The 5‐year survival rate was 71±1% for patients without CKD, 62±2% for those with mild CKD, 54±3% for those with moderate CKD, and 34±4% for those with severe CKD (P<0.001). By multivariable analysis, patients with moderate or severe CKD had a significantly higher risk of all‐cause (hazard ratio [HR] [95% CI]=1.36 [1.08–1.71]; P=0.009 and HR [95% CI]=2.16 [1.67–2.79]; P<0.001, respectively) and cardiovascular mortality (HR [95% CI]=1.39 [1.03–1.88]; P=0.031 and HR [95% CI]=1.69 [1.18–2.41]; P=0.004, respectively) than patients without CKD. Despite more symptoms, AVR was less frequent in moderate (P=0.002) and severe CKD (P<0.001). AVR was associated with a marked reduction in all‐cause and cardiovascular mortality versus conservative management for each CKD group (all P<0.001). The joint‐test showed no interaction between AVR and CKD stages (P=0.676) indicating a nondifferentialeffect of AVR across stages of CKD. After propensity matching, AVR was still associated with substantially better survival for each CKD stage relative to conservative management (all P<0.0017). Conclusions In severe aortic stenosis, moderate and severe CKD are associated with increased mortality and decreased referral to AVR. AVR markedly reduces all‐cause and cardiovascular mortality, regardless of the CKD stage. Therefore, CKD should not discourage physicians from considering AVR.
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Affiliation(s)
- Yohann Bohbot
- Department of Cardiology Amiens University Hospital Amiens France.,UR UPJV 7517 Jules Verne University of Picardie Amiens France
| | - Alexandre Candellier
- UR UPJV 7517 Jules Verne University of Picardie Amiens France.,Department of Nephrology Amiens University Hospital Amiens France
| | - Momar Diouf
- Department of Clinical Research Amiens University Hospital Amiens France
| | - Dan Rusinaru
- Department of Cardiology Amiens University Hospital Amiens France.,UR UPJV 7517 Jules Verne University of Picardie Amiens France
| | - Alexandre Altes
- Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine Université Lille Nord de France Lille France
| | - Agnes Pasquet
- Pôle de Recherche Cardiovasculaire Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium.,Division of Cardiology Cliniques Universitaires Saint-Luc Brussels Belgium
| | - Sylvestre Maréchaux
- UR UPJV 7517 Jules Verne University of Picardie Amiens France.,Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine Université Lille Nord de France Lille France
| | - Jean-Louis Vanoverschelde
- Pôle de Recherche Cardiovasculaire Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium.,Division of Cardiology Cliniques Universitaires Saint-Luc Brussels Belgium
| | - Christophe Tribouilloy
- Department of Cardiology Amiens University Hospital Amiens France.,UR UPJV 7517 Jules Verne University of Picardie Amiens France
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Impact of Transcatheter Aortic Valve Replacement on Severity of Chronic Kidney Disease. J Am Coll Cardiol 2020; 76:1410-1421. [DOI: 10.1016/j.jacc.2020.07.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 11/20/2022]
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34
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Kaur P, Ajibawo T, Yomi T, Patel N, Baksh M, Okotcha E, Kataria S, Patel RS. Aortic Stenosis Patients With Transcatheter Aortic Valve Replacement: Caution Recommended With Renal Failure During Hospitalization. Cureus 2020; 12:e9384. [PMID: 32850251 PMCID: PMC7445110 DOI: 10.7759/cureus.9384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective Our study aimed to assess the risk of in-patient mortality due to renal failure and other comorbidities in aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR). Methods We conducted a cross-sectional study using a Nationwide Inpatient Sample (NIS, January 2010 to December 2014) from the United States and included 33,325 patients with a primary diagnosis of AS. Logistic regression was used to evaluate the odds ratio (OR) for in-hospital mortality in AS by comorbidities including renal failure. Results The prevalence of renal failure in AS patients is 29.2%, and a higher proportion were males (60.1%) and non-white (14.1%). Major loss of function (96.6%) and in-hospital mortality (5.1%) were also proportionally higher in prevalence. Female patients (OR 1.35, 95% CI 1.20-1.51) had higher odds of in-patient mortality in AS patients. Race was a non-significant predictor for mortality risk. Patients with comorbid coagulopathy (OR 2.02, 95% CI 1.79-2.27) and heart failure (OR 1.62, 95% CI 1.39-1.89) have increased mortality in AS inpatients. After controlling confounders, renal failure was significantly associated with increased in-hospital mortality (OR 1.43, 95% CI 1.28-1.61) in AS patients. Conclusion Renal failure was prevalent in AS patients and was an independent factor that increases the risk of in-hospital mortality by 43%. Due to worse outcomes, more studies are required to evaluate risk-benefit ratio and strategies to improve health-related quality of life in post-TAVR patients with renal failure, and optimally decrease inpatient mortality.
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Affiliation(s)
- Pawandeep Kaur
- Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
| | - Timiiye Yomi
- Medicine, University of Benin School of Medicine, Benin City, NGA
| | - Neev Patel
- Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Mizba Baksh
- Internal Medicine, Dr. Nandamuri Taraka Rama Rao University of Health Sciences, Vijayawada, IND
| | - Edmond Okotcha
- Medicine, Vinnytsia Pirogov National Medical University, Vinnytsia Oblast, UKR
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35
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Adamo M, Provini M, Fiorina C, Giannini C, Angelillis M, Testa L, Barbanti M, Merlanti B, Poli A, Ferrara E, Latib A, Reimers B, Maffeo D, Bruschi G, Montorfano M, Petronio AS, Bedogni F, Tamburino C, Metra M, Curello S. Interaction between severe chronic kidney disease and acute kidney injury in predicting mortality after transcatheter aortic valve implantation: Insights from the Italian Clinical Service Project. Catheter Cardiovasc Interv 2020; 96:1500-1508. [DOI: 10.1002/ccd.28927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Marianna Adamo
- Cardiothoracic Department, ASST Spedali Civili di Brescia Brescia Italy
| | - Martino Provini
- Cardiothoracic Department, ASST Spedali Civili di Brescia Brescia Italy
| | - Claudia Fiorina
- Cardiothoracic Department, ASST Spedali Civili di Brescia Brescia Italy
| | | | | | - Luca Testa
- Cardiology Department, IRCCS Policlinico San Donato Milan Italy
| | - Marco Barbanti
- Division of Cardiology, CAST Azienda Ospedaliero‐Universitaria Policlinico‐Vittorio Emanuele Catania Italy
| | - Bruno Merlanti
- “De Gasperis” Cardio Center, ASST Niguarda Metropolitan Hospital Milan Italy
| | - Arnaldo Poli
- Interventional Cardiology Unit, Legnano Civil Hospital Legnano Italy
| | - Erica Ferrara
- Interventional Cardiology Unit, Legnano Civil Hospital Legnano Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute Milan Italy
| | | | - Diego Maffeo
- Cardiovascular Department, Fondazione Poliambulanza Brescia Italy
| | - Giuseppe Bruschi
- “De Gasperis” Cardio Center, ASST Niguarda Metropolitan Hospital Milan Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute Milan Italy
| | | | | | - Corrado Tamburino
- Division of Cardiology, CAST Azienda Ospedaliero‐Universitaria Policlinico‐Vittorio Emanuele Catania Italy
| | - Marco Metra
- Cardiothoracic Department, ASST Spedali Civili di Brescia Brescia Italy
| | - Salvatore Curello
- Cardiothoracic Department, ASST Spedali Civili di Brescia Brescia Italy
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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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Li SX, Patel NK, Flannery LD, Cigarroa RJ, Shaqdan AW, Erickson P, Tavil‐Shatelyan A, Moses A, Inglessis I, Elmariah S. Impact of bleeding after transcatheter aortic valve replacement in patients with chronic kidney disease. Catheter Cardiovasc Interv 2020; 97:E172-E178. [DOI: 10.1002/ccd.28989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/17/2020] [Accepted: 05/06/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Shawn X. Li
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Nilay K. Patel
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Laura D. Flannery
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Ricardo J. Cigarroa
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Ayman W. Shaqdan
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Phoebe Erickson
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | | | - Alexandra Moses
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Ignacio Inglessis
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Sammy Elmariah
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
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38
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Vollema EM, Prihadi EA, Ng ACT, Gegenava T, Ajmone Marsan N, Bax JJ, Delgado V. Prognostic Implications of Renal Dysfunction in Patients With Aortic Stenosis. Am J Cardiol 2020; 125:1108-1114. [PMID: 31982104 DOI: 10.1016/j.amjcard.2019.12.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 01/22/2023]
Abstract
Aortic stenosis (AS) and renal dysfunction share risk factors and often occur simultaneously. The influence of renal dysfunction on the prognosis of patients with various grades of AS has not been extensively described. The present study aimed to assess the prognostic implications of renal dysfunction in a large cohort of patients with aortic sclerosis and patients with various grades of AS. Patients diagnosed with various grades of AS by transthoracic echocardiography were assessed and divided according to renal function by estimated glomerular filtration rate (eGFR). The occurrence of all-cause mortality (primary end point) and aortic valve replacement (AVR) was noted. Of 1,178 patients (mean age 70 ± 13 years, 60% male), 327 (28%) had aortic sclerosis, 86 (7%) had mild AS, 285 (24%) had moderate AS, and 480 (41%) had severe AS. Renal dysfunction (eGFR <60 ml/min/1.73 m2) was present in 440 (37%) patients, and moderate to severe AS was observed more often in these patients compared to patients without (70 vs 62%, respectively; p = 0.008). After a median follow-up of 95 [31 to 149] months, 626 (53%) patients underwent AVR and 549 (47%) patients died. Severely impaired renal function (eGFR <30 ml/min/1.73 m2) and AVR were independently associated with all-cause mortality after correcting for AS severity. In conclusion, renal dysfunction is highly prevalent in patients with various grades of AS. After correcting for AS severity and AVR, severely impaired renal function (eGFR <30 ml/min/1.73 m2) was independently associated with all-cause mortality. Independent of renal function, AVR was associated with improved survival.
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Affiliation(s)
- E Mara Vollema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Tea Gegenava
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Preoperative frailty parameters as predictors for outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis. Neth Heart J 2020; 28:280-292. [PMID: 32189208 PMCID: PMC7190780 DOI: 10.1007/s12471-020-01379-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Guidelines suggest using frailty characteristics in the work-up for a transcatheter aortic valve implantation (TAVI). There are many frailty-screening tools with different components. The prognostic value of the individual parameters in frailty is as yet unclear. The objective of this systematic review and meta-analysis was to find and pool predictors for 1‑year mortality after TAVI. We followed a two-step approach. First, we searched for randomised controlled trials on TAVI to identify frailty parameters used in these studies. Second, we searched for publications on these frailty parameters. Articles were included for pooled analysis if the studied frailty parameters were dichotomised with clear cut-off values based on common standards or clinical practice and reported adjusted hazard ratios (HR) of 1‑year mortality after TAVI. We calculated pooled effect estimates of 49 studies based on dichotomised frailty scores (HR: 2.16, 95% CI: 1.57–3.00), chronic lung disease (HR: 1.57, 95% CI: 1.45–1.70), estimated glomerular filtration rate <30 ml/min (HR: 1.95, 95% CI: 1.68–2.29), body mass index <20 kg/m2 (HR: 1.49, 95% CI: 1.09–2.03), hypoalbuminaemia (HR: 1.77, 95% CI: 1.38–2.25), anaemia (HR: 2.08, 95% CI: 0.93–4.66), low gait speed (HR: 13.33, 95% CI: 1.75–101.49) and Katz activities of daily living (ADL) score of 1 or more deficits (HR: 5.16, 95% CI: 0.77–34.47). Chronic lung disease, chronic kidney disease, underweight, hypoalbuminaemia, a low frailty score, anaemia, low gait speed and an ADL deficiency were associated with worse 1‑year outcomes after TAVI.
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40
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Kinnel M, Faroux L, Villecourt A, Tassan-Mangina S, Heroguelle V, Nazeyrollas P, Poncet A, Ruggieri VG, Metz D. Abdominal aorta tortuosity on computed tomography identifies patients at risk of complications during transfemoral transcatheter aortic valve replacement. Arch Cardiovasc Dis 2020; 113:159-167. [DOI: 10.1016/j.acvd.2019.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/02/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
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Bandyopadhyay D, Sartori S, Baber U, Cao D, Chandiramani R, Tchétché D, Petronio AS, Mehilli J, Lefèvre T, Presbitero P, Capranzaro P, Sardella G, Van Mieghem NM, Chandrasekhar J, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail GW, Naber C, Kini A, Morice M, Claessen BE, Chieffo A, Mehran R. The impact of chronic kidney disease in women undergoing transcatheter aortic valve replacement: Analysis from the Women's INternational Transcatheter Aortic Valve Implantation (WIN‐TAVI) registry. Catheter Cardiovasc Interv 2020; 96:198-207. [DOI: 10.1002/ccd.28752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | - Rishi Chandiramani
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | | | | | - Julinda Mehilli
- Department of CardiologyLudwig‐Maximilians‐University of Munich Munich Germany
| | - Thierry Lefèvre
- Department of Cardiology, Institut Hospitalier Jacques CartierRamsay Générale de Santé Massy France
| | | | | | - Gennaro Sardella
- Department of CardiologyPoliclinico “Umberto I,” Sapienza University of Rome Rome Italy
| | | | - Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | | | | | | | - Ghada W. Mikhail
- Department of CardiologyImperial College Healthcare NHS Trust, Hammersmith Hospital London UK
| | - Christoph Naber
- Department of Cardiology, Contilia Heart and Vascular CentreElisabeth‐Krankenhaus, Essen Essen Germany
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | - Marie‐Claude Morice
- Department of Cardiology, Institut Hospitalier Jacques CartierRamsay Générale de Santé Massy France
| | - Bimmer E. Claessen
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
| | - Alaide Chieffo
- Department of CardiologySan Raffaele Scientific Institute Milan Italy
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York New York
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42
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Kumar V, Seth A. Transcatheter aortic valve replacement: Protect the kidneys to protect the patient. Catheter Cardiovasc Interv 2020; 93:749-750. [PMID: 30859729 DOI: 10.1002/ccd.28182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 11/06/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) seems superior to surgical aortic valve replacement (SAVR) for intermediate-term outcomes in patients with aortic stenosis and moderate to severe chronic kidney disease (CKD). Intermediate-term mortality and the major adverse cardiac and renal event increase if the renal function worsens soon after TAVR or SAVR. Patient's demographic profile, comorbid conditions, and procedural characteristics influence the clinical outcomes emphasizing the need for careful risk assessment in deciding TAVR versus SAVR in CKD patient.
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Affiliation(s)
- Vijay Kumar
- Interventional Cardiology & Structural Therapies, Fortis Escorts Heart Institute, New Delhi, India
| | - Ashok Seth
- Interventional Cardiology & Structural Therapies, Fortis Escorts Heart Institute, New Delhi, India
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43
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Santis AD. Impact of Transcatheter Aortic Valve Implantation on Kidney Function: the "Renovalvular" Interaction in Aortic Stenosis. Arq Bras Cardiol 2019; 113:1112-1113. [PMID: 31800686 PMCID: PMC7021270 DOI: 10.36660/abc.20190753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Antonio de Santis
- Universidade de São Paulo Instituto do Coração - Unidade Clinica de Valvopatia, São Paulo, SP - Brazil
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44
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Heidari B, Al-Hijji MA, Moynagh MR, Takahashi N, Welle G, Eleid M, Singh M, Gulati R, Rihal CS, Lerman A. Transcatheter aortic valve replacement outcomes in patients with sarcopaenia. EUROINTERVENTION 2019; 15:671-677. [PMID: 31062696 DOI: 10.4244/eij-d-19-00110] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Sarcopaenia is a prevalent disease of ageing, associated with adverse clinical outcomes. We aimed to compare in-hospital adverse outcomes and overall mortality in sarcopaenic and non-sarcopaenic patients undergoing transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS This was a retrospective cohort study including 602 patients who underwent TAVR. Sarcopaenia was defined as skeletal muscle mass index <55.4 cm2/m2 in males and <38.9 cm2/m2 in females obtained through pre-TAVR CT scan. Mortality, length of hospital stay, ICU admission, and Valve Academic Research Consortium (VARC)-2-defined post-TAVR complications were defined as outcomes. Study participants (mean age 80.9±8.9 years and 56.8% male) were followed for a median of 1.5 years. Two thirds of the TAVR population was sarcopaenic. In-hospital outcomes were similar in both groups; however, overall survival was worse in sarcopaenic patients (HR for mortality=1.46 [1.06-2.14], p=0.02). In a multivariable model, sarcopaenia, porcelain aorta, pre-TAVR atrial fibrillation/flutter, severe chronic kidney disease, chronic pulmonary disease, VARC-2 bleeding, acute renal failure following TAVR, and post-TAVR cardiac arrest were predictors of mortality. CONCLUSIONS Sarcopaenic patients had similar in-hospital clinical outcomes to non-sarcopaenic patients following TAVR which reveals TAVR safety in sarcopaenic patients. However, sarcopaenia was an independent risk factor for midterm mortality indicating its potential value in systematic evaluation of this highly comorbid population in order to decide the best treatment approaches.
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Affiliation(s)
- Behnam Heidari
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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45
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Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019; 96:836-849. [DOI: 10.1016/j.kint.2019.06.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/21/2022]
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Chronic Kidney Disease and the Pathophysiology of Valvular Heart Disease. Can J Cardiol 2019; 35:1195-1207. [DOI: 10.1016/j.cjca.2019.05.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/03/2019] [Accepted: 05/21/2019] [Indexed: 01/01/2023] Open
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Witberg G, Patterson T, Redwood S, Prendergast B. Perspectivas futuras. Implante percutáneo de válvula aórtica para pacientes en bajo riesgo: ¿una realidad a corto plazo o se debe esperar? Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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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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Witberg G, Patterson T, Redwood S, Prendergast B. Future Directions. Transcatheter Aortic Valve Implantation for Low-risk Patients: Inevitable Evolution or a Step Too Far? ACTA ACUST UNITED AC 2019; 72:664-671. [PMID: 30930254 DOI: 10.1016/j.rec.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/15/2019] [Indexed: 11/29/2022]
Abstract
Transcatheter aortic valve replacement has become the treatment of choice for inoperable and high-risk patients with symptomatic aortic stenosis, and is becoming more and more common as the first choice for intermediate-risk patients as well. The next step in this evolution would be the expansion of treatment indications to low-risk patients. Successful treatment of this patient population will require setting new standards in terms of clinical outcomes and cost effectiveness. In this review, we present the main challenges that need to be addressed before transcatheter aortic valve replacement can be applied as a standard treatment for low-risk patients.
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom.
| | - Tiffany Patterson
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom
| | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom
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Takagi H, Hari Y, Kawai N, Kuno T, Ando T. Meta-analysis of impact of liver disease on mortality after transcatheter aortic valve implantation. J Cardiovasc Med (Hagerstown) 2019; 20:237-244. [DOI: 10.2459/jcm.0000000000000777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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