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Färber G, Bleiziffer S, Doenst T, Bon D, Böning A, Weiler H, Herrmann E, Frerker C, Beckmann A, Möllmann H, Ensminger S, Bekeredjian R, Walther T, Harringer W, Katus HA, Hamm CW, Beyersdorf F, Bauer T, Fichtlscherer S. Transcatheter or surgical aortic valve implantation in chronic dialysis patients: a German Aortic Valve Registry analysis. Clin Res Cardiol 2020; 110:357-367. [DOI: 10.1007/s00392-020-01717-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/22/2020] [Indexed: 12/19/2022]
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Allende R, Webb JG, Munoz-Garcia AJ, de Jaegere P, Tamburino C, Dager AE, Cheema A, Serra V, Amat-Santos I, Velianou JL, Barbanti M, Dvir D, Alonso-Briales JH, Nuis RJ, Faqiri E, Imme S, Benitez LM, Cucalon AM, Al Lawati H, Garcia del Blanco B, Lopez J, Natarajan MK, DeLarochellière R, Urena M, Ribeiro HB, Dumont E, Nombela-Franco L, Rodés-Cabau J. Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes and prognostic markers from a large cohort of patients. Eur Heart J 2014; 35:2685-96. [PMID: 24796337 DOI: 10.1093/eurheartj/ehu175] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIM The aim of this study was to determine the effects of advanced chronic kidney disease (CKD) on early and late outcomes after transcatheter aortic valve implantation (TAVI), and to evaluate the predictive factors of poorer outcomes in such patients. METHODS AND RESULTS This was a multicentre study including a total of 2075 consecutive patients who had undergone TAVI. Patients were grouped according the estimated glomerular filtration rate as follows: CKD stage 1-2 (≥60 mL/min/1.73 m(2); n = 950), stage 3 (30-59 mL/min/1.73 m(2); n = 924), stage 4 (15-29 mL/min/1.73 m(2); n = 134) and stage 5 (<15 mL/min/1.73 m² or dialysis; n = 67). Clinical outcomes were evaluated at 30-days and at follow-up (median of 15 [6-29] months) and defined according to the VARC criteria. Advanced CKD (stage 4-5) was an independent predictor of 30-day major/life-threatening bleeding (P = 0.001) and mortality (P = 0.027), and late overall, cardiovascular and non-cardiovascular mortality (P < 0.01 for all). Pre-existing atrial fibrillation (HR: 2.29, 95% CI: 1.47-3.58, P = 0.001) and dialysis therapy (HR: 1.86, 95% CI: 1.17-2.97, P = 0.009) were the predictors of mortality in advanced CKD patients, with a mortality rate as high as 71% at 1-year follow-up in those patients with these 2 factors. Advanced CKD patients who had survived at 1-year follow-up exhibited both a significant improvement in NYHA class (P < 0.001) and no deterioration in valve hemodynamics (P = NS for changes in mean gradient and valve area over time). CONCLUSIONS Advanced CKD was associated with a higher rate of early and late mortality and bleeding events following TAVI, with AF and dialysis therapy determining a higher risk in these patients. The mortality rate of patients with both factors was unacceptably high and this should be taken into account in the clinical decision-making process in this challenging group of patients.
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Affiliation(s)
- Ricardo Allende
- Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada
| | - John G Webb
- St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | - Vicenç Serra
- Hospital General Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Marco Barbanti
- St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Danny Dvir
- St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | - Javier Lopez
- Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Marina Urena
- Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada
| | - Henrique B Ribeiro
- Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada
| | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada
| | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada
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