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Koga M, Izumo M, Kobayashi Y, Kai T, Okuno T, Sato Y, Kuwata S, Okuyama K, Ishibashi Y, Tanabe Y, Akashi YJ. Safety and feasibility of zero-contrast transcatheter aortic valve implantation using balloon-expandable valves in patients with aortic stenosis and severe renal impairment: A single-center study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:68-76. [PMID: 37500393 DOI: 10.1016/j.carrev.2023.07.014] [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: 04/07/2023] [Revised: 06/23/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Aortic stenosis (AS) and chronic kidney disease (CKD) can coexist. Repeat exposure to contrast media in patients undergoing transcatheter aortic valve implantation (TAVI) has latent mortality risks and increased risk for acute kidney injury. We aimed to assess our "zero-contrast TAVI" protocol for patients with advanced CKD. METHODS Consecutive patients with severe AS who underwent TAVI at a single center registry were enrolled. Zero-contrast TAVI group included patients who underwent TAVI without contrast and who had an estimated glomerular filtration rate <30 mL/min/1.73 m2. Conventional TAVI group included patients who underwent the regular TAVI procedure. Patients using balloon-expandable valves via transfemoral approach were analyzed. Baseline clinical and procedural characteristics and clinical outcomes were compared between two groups. The primary outcome was early safety as defined by Valve Academic Research Consortium Criteria. Secondary outcomes included the presence of severe prosthesis-patient mismatch, moderate or greater perivalvular leakage, and requirement for new dialysis (within 3 months). RESULTS A total of 520 patients were analyzed. Among these, 32 (6 %) underwent zero-contrast TAVI and 488 (94 %) conventional TAVI. In the zero-contrast TAVI group, 12 patients (37.5 %) had to use 20.7 (11.0-31.2) mL of contrast media. There were no significant differences in the primary and secondary outcomes between zero-contrast TAVI and conventional TAVI groups (78.1 % vs. 86.8 %, P = 0.184 and 9.4 % vs. 8.1 %, P = 0.738 for the primary and secondary outcomes, respectively). CONCLUSIONS Zero-contrast TAVI is feasible, safe, and effective in patients with AS and stage 4 CKD.
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Affiliation(s)
- Masashi Koga
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan.
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yoshikuni Kobayashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Takahiko Kai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Taishi Okuno
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yukio Sato
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Shingo Kuwata
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Kazuaki Okuyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
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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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Benaicha K, Aldroubi B, Yousuf P, Nath R, Saveeta F, Kanwal F, Fatima T, Hirani S. Factors Associated With Acute Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e45131. [PMID: 37842473 PMCID: PMC10569799 DOI: 10.7759/cureus.45131] [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] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
The aim of this meta-analysis is to assess the effect of different independent predictors on acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI). This meta-analysis adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive database search was conducted using PubMed, Web of Science, and Scopus for the period from January 1, 2015, to August 15, 2023. The following key terms were employed: "transcatheter aortic valve implantation" OR "transcatheter aortic valve replacement" AND "acute kidney injury" OR "acute renal failure." Our search was limited to studies published exclusively in the English language. The statistical analysis was conducted using RevMan version 5.4.1 (The Cochrane Collaboration). Estimates were presented as odds ratio (OR) with 95% confidence interval (CI) for categorical variables, while continuous variables were reported as mean difference (MD) with 95% CI. A total of 19 studies met the selection criteria and were included in the meta-analysis. The pooled incidence of AKI was reported as 20% (95% CI: 18-20%). Factors significantly associated with post-TAVI AKI encompass hypertension, chronic kidney disease (CKD), low estimated glomerular filtration rate (eGFR), high baseline creatinine levels, peripheral vascular disease (PVD), Society of Thoracic Surgeons (STS) score, European System for Cardiac Operative Risk Evaluation (EUROscore) II, and the transfemoral surgical approach.
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Affiliation(s)
- Karima Benaicha
- Internal Medicine, University Hospital Isaad Hassani Beni Messous, Algiers, DZA
| | | | - Paras Yousuf
- Emergency Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | - Fnu Saveeta
- Internal Medicine, People's University of Medical and Health Sciences, Nawabshah, PAK
| | - Fnu Kanwal
- Medical College, Chandka Medical College, Larkana, PAK
| | - Tehreem Fatima
- Internal Medicine, United Medical and Dental College, Creek General Hospital, Karachi, PAK
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Rivera FB, Al-Abcha A, Ansay MFM, Magalong JVU, Tang VAS, Ona HM, Miralles KA, Sausa R, Uy RAF, Lerma EV, Collado FMS, McCullough PA, Volgman AS. Transcatheter Aortic Valve Replacement-Associated Acute Kidney Injury: An Update. Cardiorenal Med 2023; 13:143-157. [PMID: 36801854 DOI: 10.1159/000529729] [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: 09/14/2022] [Accepted: 02/01/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a relatively novel minimally invasive procedure for the treatment of symptomatic patients with severe aortic stenosis. Although it has been proven effective in improving mortality and quality of life, TAVR is associated with serious complications, such as acute kidney injury (AKI). SUMMARY TAVR-associated AKI is likely due to several factors such as sustained hypotension, transapical approach, volume of contrast use, and baseline low GFR. This narrative review aims to present an overview of the latest literature and evidence regarding the definition of TAVR-associated AKI, its risk factors, and its impact on morbidity and mortality. The review used a systematic search strategy with multiple health-focused databases (Medline, EMBASE) and identified 8 clinical trials and 27 observational studies concerning TAVR-associated AKI. Results showed that TAVR-associated AKI is linked to several modifiable and nonmodifiable risk factors and is associated with higher mortality. A variety of diagnostic imaging modalities have the potential to identify patients at high risk for development of TAVR-AKI; however, there are no existing consensus recommendations regarding their use as of this time. The implications of these findings highlight the importance of identifying high-risk patients for which preventive measures may play a crucial role, and should be maximized. KEY MESSAGE This study reviews the current understanding of TAVR-associated AKI including its pathophysiology, risk factors, diagnostic modalities, and preventative management for patients.
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Affiliation(s)
| | | | | | | | | | - Hannah May Ona
- University of the Philippines College of Medicine, Manila, Philippines
| | | | - Rausche Sausa
- University of the Philippines College of Medicine, Manila, Philippines
| | | | - Edgar V Lerma
- Section of Nephrology, University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Oak Lawn, Illinois, USA
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Zubarevich A, Szczechowicz M, Jánosi RA, Lind A, Rassaf T, Malik R, Thielmann M, Schmack B, Kamler M, Ruhparwar A, Weymann A, Wendt D. Alternative access in high-risk patients in the era of transfemoral aortic valve replacement. MINIM INVASIV THER 2021; 31:909-916. [PMID: 34915823 DOI: 10.1080/13645706.2021.2015392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND We aimed to evaluate the outcomes of transapical and transaortic transcatheter aortic valve replacement (TAVR) in high-risk patients who were not suitable for transfemoral access and had a logistic EuroSCORE-I ≥ 25% and Society of Thoracic Surgeons (STS) score >6%. 'STS/ACC TAVR In-Hospital Mortality Risk App' was evaluated. MATERIAL AND METHODS Between January 2016 and May 2020, 126 patients at very high risk for aortic valve replacement underwent transapical (n = 121) or transaortic (n = 5) transcatheter aortic valve replacement. TAVR was performed using SAPIEN 3™ or ACURATE TA™ prosthesis. RESULTS The logistic EuroSCORE-I was 40.6 ± 14.0%, the STS-score 7.9 ± 4.6%, and STS/ACC-score 8.4 ± 3.4%. Valve implantation was successful in all patients. Operative, in-hospital and 30-days mortality, were 0, 7.9, and 13.5%, respectively. Survival was 72% at one year and 48% at four years. Expected/observed in-hospital mortality was 1.0 for the STS-score and 1.06 for the STS/ACC-score. Renal failure, low ejection fraction, and postoperative acute kidney injury, hemorrhage, and vascular complications were identified as independent predictors for 30-day mortality. CONCLUSIONS Transapical and transaortic TAVR in high-risk patients unsuitable for transfemoral access is still a reasonable alternative in these patients. STS and STS/ACC-score appear to be highly accurate in predicting in-hospital mortality in high-risk patients undergoing TAVR.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Rolf-Alexander Jánosi
- Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, Essen, Germany
| | - Alexander Lind
- Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, Essen, Germany
| | - Rizwan Malik
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
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Kidney injury as post-interventional complication of TAVI. Clin Res Cardiol 2020; 110:313-322. [PMID: 32844282 DOI: 10.1007/s00392-020-01732-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an accepted treatment approach of aortic stenosis. In the beginning, this technique was executed in high-risk patients only. Today, intermediate-risk patients are also amenable for TAVI, as long as the transfemoral approach is chosen. Numerous predictors have been identified that could lead to periprocedural complications and are defined by patient co-morbidities as well as being inherent to the technical approach. Although vascular complications and postinterventional paravalvular regurgitation have been minimized over the past years by revised technologies and techniques, there is a prevailing individual risk brought about by the specific pathophysiology of the cardiorenal syndrome.
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