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Dong Z, Yao J, Li R, Liu X, Yuan F, Luo T, Zhang Q, Song G. Perioperative renal function change after transcatheter aortic valve replacement: A single-center retrospective study in China. Perfusion 2024; 39:759-765. [PMID: 36856783 DOI: 10.1177/02676591231158742] [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: 03/02/2023]
Abstract
BACKGROUND In recent years, the kidney function after Transcatheter Aortic Valve Replacement (TAVR) has gradually become a hot spot that arouse extensive attention.Our study is aimed to evaluate the incidence and predictors of acute kidney recovery (AKR) after TAVR. METHODS A total of 102 patients undergoing TAVR in Beijing Anzhen Hospital from June 2021 to March 2022 were enrolled in our study. Patients were divided into AKR group (n = 54), unchanged group (n = 40) and acute kidney injury (AKI) group (n = 8) based on the percent change of estimated glomerular filtration rate (eGFR). Univariate analysis was used to compare the differences in general clinical characteristics and other related indicators between the three groups to analyze the risk factors of AKR. RESULTS The incidence of AKR was 53% (54/102) after TAVR. Multivariate analysis showed that the incidence of age and proportion of severe NYHA class (III or IV) was significantly higher in the AKR group while renal dysfunction (eGFR <60 mL/min/1.73 m2) was lower. Besides, fluid management/volume therapy was significantly different among the three groups. CONCLUSIONS AKR is a generalizable phenomenon occurring frequently after TAVR. The age, proportion of severe NYHA class and the baseline renal function are independent predictors of AKR events in patients with severe aortic stenosis undergoing TAVR.
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Affiliation(s)
- Zhe Dong
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Jing Yao
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui Li
- Department of Health Care, China-Japan Friendship Hospital, Beijing, China
| | - Xinmin Liu
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fei Yuan
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Taiyang Luo
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qian Zhang
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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2
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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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3
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Tomey MI. Intensive Care after Transcatheter Aortic Valve Replacement. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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4
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Venturi G, Scarsini R, Pighi M, Kotronias RA, Piccoli A, Lunardi M, Del Sole P, Mainardi A, Gambaro A, Tavella D, De Maria GL, Kharbanda R, Pesarini G, Banning A, Ribichini F. Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI. Catheter Cardiovasc Interv 2022; 99:1925-1934. [PMID: 35312158 PMCID: PMC9546166 DOI: 10.1002/ccd.30156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/05/2022] [Indexed: 11/27/2022]
Abstract
The volume of contrast to creatinine clearance ratio (CV/CrCl) is a useful indicator of the risk of acute kidney injury (AKI) in patients undergoing percutaneous interventional procedures. Association between CV/CrCl and adverse outcome after transcatheter aortic valve implantation (TAVI) was suggested but it is not well established. A large retrospective multicenter cohort of 1381 patients treated with TAVI was analyzed to assess the association between CV/CrCl and the risk of AKI and mortality at 90 days and 1 year after TAVI. Patients receiving renal replacement therapy at the time of TAVI were excluded. CV/CrCl ≥ 2.2 was associated with the risk of AKI and 90 days mortality after TAVI after adjustment for age, sex, diabetes, baseline left ventricular function, baseline chronic kidney disease (CKD), previous myocardial infarction and peripheral vascular disease (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.09-1.22, p < 0.0001). Importantly, CV/CrCl was associated with the adverse outcome independently from the presence of baseline CKD (p for interaction = 0.22). CV/CrCl was independently associated with the individual components of the composite primary outcome including AKI (odds ratio: 1.18, 95% CI: 1.08-1.28, p < 0.0001) and 90 days mortality (HR: 1.90, 95% CI: 1.01-3.60, p = 0.047) after TAVI. AKI (HR: 1.94, 95% CI: 1.21-3.11, p = 0.006) but not CV/CrCl was associated with the risk of 1-year mortality after TAVI. CV/CrCl is associated with excess renal damage and early mortality after TAVI. Procedural strategies to minimize the CV/CrCl during TAVI may improve early clinical outcomes in patients undergoing TAVI.
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Affiliation(s)
- Gabriele Venturi
- Cardiology Division, Department of MedicineUniversity of VeronaVeronaItaly
| | - Roberto Scarsini
- Cardiology Division, Department of MedicineUniversity of VeronaVeronaItaly
| | - Michele Pighi
- Cardiology Division, Department of MedicineUniversity of VeronaVeronaItaly
| | | | - Anna Piccoli
- Cardiology Division, Department of MedicineUniversity of VeronaVeronaItaly
| | - Mattia Lunardi
- Cardiology Division, Department of MedicineUniversity of VeronaVeronaItaly
| | - Paolo Del Sole
- Cardiology Division, Department of MedicineUniversity of VeronaVeronaItaly
| | - Andrea Mainardi
- Cardiology Division, Department of MedicineUniversity of VeronaVeronaItaly
| | - Alessia Gambaro
- Cardiology Division, Department of MedicineUniversity of VeronaVeronaItaly
| | - Domenico Tavella
- Cardiology Division, Department of MedicineUniversity of VeronaVeronaItaly
| | | | | | - Gabriele Pesarini
- Cardiology Division, Department of MedicineUniversity of VeronaVeronaItaly
| | - Adrian Banning
- John Radcliffe Oxford University Hospital, NHS TrustOxfordUK
| | - Flavio Ribichini
- Cardiology Division, Department of MedicineUniversity of VeronaVeronaItaly
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5
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Cigarroa R, Shaqdan AW, Patel V, Selberg AM, Kandanelly RR, Erickson P, Furman D, Sodhi N, Vatterott A, Palacios IF, Passeri JJ, Vlahakes GJ, Sakhuja R, Inglessis I, Rhee EP, Lindman BR, Elmariah S. Relation of Subacute Kidney Injury to Mortality After Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 165:81-87. [PMID: 34920860 DOI: 10.1016/j.amjcard.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
Acute kidney injury after transcatheter aortic valve implantation (TAVI) has been associated with adverse outcomes; however, data are limited on the subacute changes in renal function that occur after discharge and their impact on clinical outcomes. This study investigates the relation between subacute changes in kidney function at 30 days after TAVI and survival. Patients from 2 centers who underwent TAVI and survived beyond 30 days with baseline, in-hospital, and 30-day measures of renal function were retrospectively analyzed. Patients were stratified based on change in estimated glomerular filtration rate (eGFR) from baseline to 30 days as follows: improved (≥15% higher than baseline), worsened (≤15% lower), or unchanged (values in between). Univariable and multivariable models were constructed to identify predictors of subacute changes in renal function and of 2-year mortality. Of the 492 patients who met inclusion criteria, eGFR worsened in 102 (22%), improved in 110 (22%), and was unchanged in 280 (56%). AKI occurred in 90 patients (18%) and in only 27% of patients with worsened eGFR at 30 days. After statistical adjustment, worsened eGFR at 30 days (hazard ratio vs unchanged eGFR 2.09, 95% CI 1.37 to 3.19, p <0.001) was associated with worse survival, whereas improvement in renal function was not associated with survival (hazard ratio vs unchanged eGFR 1.30, 95% CI 0.79 to 2.11, p = 0.30). Worsened renal function at 30 days after TAVI is associated with increased mortality after TAVI. In conclusion, monitoring renal function after discharge may identify patients at high risk of adverse outcomes.
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Affiliation(s)
- Ricardo Cigarroa
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Ayman W Shaqdan
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Vaiibhav Patel
- Cardiology Division, Department of Medicine, University of Michigan Hospital, Ann Arbor, Michigan
| | - Alexandra M Selberg
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Ritvik R Kandanelly
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Phoebe Erickson
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Deborah Furman
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Nishtha Sodhi
- Cardiology Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Anna Vatterott
- Cardiology Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Igor F Palacios
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan J Passeri
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Gus J Vlahakes
- Cardiac Surgery Division, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Rahul Sakhuja
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Ignacio Inglessis
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Eugene P Rhee
- Nephrology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian R Lindman
- Cardiovascular Medicine Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
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6
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Iacovelli F, Pignatelli A, Cafaro A, Stabile E, Salemme L, Cioppa A, Pucciarelli A, Spione F, Loizzi F, De Cillis E, Pestrichella V, Bortone AS, Tesorio T, Contegiacomo G. Impact of contrast medium osmolality on the risk of acute kidney injury after transcatheter aortic valve implantation: insights from the Magna Graecia TAVI registry. Int J Cardiol 2020; 329:56-62. [PMID: 33359334 DOI: 10.1016/j.ijcard.2020.12.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/25/2020] [Accepted: 12/11/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is frequent and associated with adverse outcomes and mortality; to date, in such setting of patients there is no consistent evidence that either low-osmolar contrast media (LOCM) or iso-osmolar contrast medium (IOCM) are superior to the other in terms of renal safety. METHODS 697 consecutive patients not in hemodialysis treatment who underwent TAVI (327 males, mean age 81.01 ± 5.75 years, mean european system for cardiac operative risk evaluation II 6.17 ± 0.23%) were enrolled. According to osmolality of the different iodinated CM, the population was divided in 2 groups: IOCM (n = 370) and LOCM group (n = 327). Preoperatively, 40.54% of patients in IOCM vs 39.14% in LOCM group (p = 0.765) suffered from chronic kidney disease (CKD). RESULTS The incidence of AKI was significantly lower with IOCM (9.73%) than with LOCM (15.90%; p = 0.02), and such significant difference (p < 0.001) in postprocedural change of renal function parameters persisted at discharge too. The incidence of AKI was also significantly lower with IOCM in younger patients, without diabetes, anemia, coronary artery disease history, CKD, chronic or persistent atrial fibrillation, left ventricular ejection fraction ≤35%, and in patients with low operative mortality risk scores, receiving lower amounts of dye (p < 0.05 for all). Importantly, multivariate analysis identified LOCM administration as an independent risk factor for both AKI (p = 0.006) and 1-year mortality (p = 0.001). CONCLUSIONS The use of IOCM have a favorable impact on renal function with respect to LOCM, but it should be considered especially for TAVI patients at lower AKI risk.
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Affiliation(s)
- Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy.
| | - Antonio Pignatelli
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Bari, Italy
| | | | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Luigi Salemme
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Angelo Cioppa
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Armando Pucciarelli
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Francesco Spione
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Francesco Loizzi
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Tullio Tesorio
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Gaetano Contegiacomo
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Bari, Italy
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7
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Rzucidlo J, Jaspan V, Paone D, Jilaihawi H, Xia Y, Kapitman A, Nakashima M, He Y, Ibrahim H, Pushkar I, Neuburger PJ, Saric M, Bamira D, Paschke S, Kalish C, Staniloae C, Shah B, Williams M. Long-term outcomes after transcatheter aortic valve replacement with minimal contrast in chronic kidney disease. Catheter Cardiovasc Interv 2020; 98:319-327. [PMID: 33180381 DOI: 10.1002/ccd.29378] [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: 07/24/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with renal insufficiency have poor short-term outcomes after transcatheter aortic valve replacement (TAVR). METHODS Retrospective chart review identified 575 consecutive patients not on hemodialysis who underwent TAVR between September 2014 and January 2017. Outcomes were defined by VARC-2 criteria. Primary outcome of all-cause mortality was evaluated at a median follow-up of 811 days (interquartile range 125-1,151). RESULTS Preprocedural glomerular filtration rate (GFR) was ≥60 ml/min in 51.7%, 30-60 ml/min in 42.1%, and < 30 ml/min in 6.3%. Use of transfemoral access (98.8%) and achieved device success (91.0%) did not differ among groups, but less contrast was used with lower GFR (23 ml [15-33], 24 ml [14-33], 13 ml [8-20]; p < .001). Peri-procedural stroke (0.7%, 2.1%, 11.1%; p < .001) was higher with lower GFR. Core lab analysis of preprocedural computed tomography scans of patients who developed a peri-procedural stroke identified potential anatomic substrate for stroke in three out of four patients with GFR 30-60 ml/min and all three with GFR <30 ml/min (severe atheroma was the most common subtype of anatomical substrate present). Compared to GFR ≥60 ml/min, all-cause mortality was higher with GFR 30-60 ml/min (HR 1.61 [1.00-2.59]; aHR 1.61 [0.91-2.83]) and GFR <30 ml/min (HR 2.41 [1.06-5.48]; aHR 2.34 [0.90-6.09]) but not significant after multivariable adjustment. Follow-up echocardiographic data, available in 63%, demonstrated no difference in structural heart valve deterioration over time among groups. CONCLUSIONS Patients with baseline renal insufficiency remain a challenging population with poor long-term outcomes despite procedural optimization with a transfemoral-first and an extremely low-contrast approach.
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Affiliation(s)
- Justyna Rzucidlo
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Vita Jaspan
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Darien Paone
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Hasan Jilaihawi
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Yuhe Xia
- Department of Biostatistics, NYU Langone Health, New York, New York
| | - Anna Kapitman
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Makoto Nakashima
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Yuxin He
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Homam Ibrahim
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Illya Pushkar
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Daniel Bamira
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Sonja Paschke
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Chloe Kalish
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Cezar Staniloae
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Binita Shah
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York.,Department of Medicine, Division of Cardiology, VA New York Harbor Healthcare System: Manhattan Campus, New York, New York
| | - Mathew Williams
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
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8
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Sgura FA, Arrotti S, Magnavacchi P, Monopoli D, Gabbieri D, Banchelli F, Tondi S, Denegri A, D'Amico R, Guiducci V, Vignali L, Boriani G. Kidney dysfunction and short term all-cause mortality after transcatheter aortic valve implantation. Eur J Intern Med 2020; 81:32-37. [PMID: 32487372 DOI: 10.1016/j.ejim.2020.05.027] [Citation(s) in RCA: 8] [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: 12/14/2019] [Revised: 04/29/2020] [Accepted: 05/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) has been associated with worse outcomes. However, the impact on outcome of AKI in TAVI-patients is not well established. METHODS Inoperable patients with severe aortic stenosis (AS) undergoing TAVI in 2010-2018 were enrolled in this study. AKI and chronic kidney disease (CKD) were defined according to KDIGO guidelines. Patients were divided in two groups according to post-procedural AKI development. The primary endpoint was 30-day all-cause mortality across the two groups. RESULTS A total of 373 patients (mean age 82.3 ± 6) were analyzed. Compared to non-AKI patients, those who developed AKI, were treated more frequently with trans-apical TAVI (66% vs 35%, p<0.01), with greater amount of contrast medium (200.6 vs 170.4 ml, p=0.02) and in presence of clinically significant peripheral artery disease (PAD, 33% vs 21%, p=0.04). Trans-apical access (OR 3.24, 95% CI 1.76-5.60, p<0.01) was associated with a 3-fold risk of AKI. After adjustment for age, Society of Thoracic Surgery risk score (STS), PAD, access type, EF and contrast medium amount, patients with AKI presented an increased risk of 30-day all-cause mortality (HR=1.25, 95%CI 1.09-1.69, p=0.008). Patients with CKD IV and V, who developed AKI, presented a 9-fold 30-day mortality risk (HR=9.71, 95% CI 2.40-39.2, p=0.001). CONCLUSION In our analysis, AKI was a strong predictor of 30-day all-cause mortality. Particularly, patients with severe CKD with AKI showed the highest 30-day mortality risk. Thus, this group of patients might benefit from closer monitoring and specific kidney protection therapies.
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Affiliation(s)
- Fabio Alfredo Sgura
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | - Salvatore Arrotti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | | | - Daniel Monopoli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | | | - Federico Banchelli
- Statistic Unit, Department of Medical and Surgical Sciences, University of Modena, 41124 Modena, Italy
| | - Stefano Tondi
- Cardiology Division, Baggiovara Hospital, Modena, Italy
| | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | - Roberto D'Amico
- Statistic Unit, Department of Medical and Surgical Sciences, University of Modena, 41124 Modena, Italy
| | - Vincenzo Guiducci
- Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Luigi Vignali
- Cardiology Division, Parma University Hospital, Parma, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena.
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9
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Mach M, Hasan W, Andreas M, Winkler B, Weiss G, Adlbrecht C, Delle-Karth G, Grabenwöger M. Evaluating the Association between Contrast Medium Dosage and Acute Kidney Injury in Transcatheter Aortic Valve Replacement Using Different Predictive Models. J Clin Med 2020; 9:jcm9113476. [PMID: 33126601 PMCID: PMC7692089 DOI: 10.3390/jcm9113476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 12/20/2022] Open
Abstract
Recent studies have suggested that contrast medium (CM) volume is associated with acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR). However, in a high-risk elderly TAVR population, the prognostic value and ideal threshold of CM dosage for AKI is unclear. Data of 532 successive TAVR patients (age 81.1 ± 6.8 years, EuroSCORE II 4.8% ± 6.0%) were therefore retrospectively analyzed. Based on a recently published formula, the renal function (preprocedural serum creatinine: SCr) corrected ratio of CM and body weight (CM*SCr/BW) was calculated to determine the risk of postprocedural contrast-associated AKI. AKI occurred in 94 patients (18.3%) and significantly increased 1-year all-cause mortality (23.4% vs. 13.1%; p = 0.001). A significant correlation between AKI and 30-day as well as 1-year all-cause mortality was observed (p = 0.001; p = 0.007). However, no association between CM dosage or the CM*SCr/BW ratio with the occurrence of AKI was seen (p = 0.968; p = 0.442). In our all-comers, all-access cohort, we found no relationship between CM dosage, or the established risk ratio model and the occurrence of postprocedural AKI. Further research needs to be directed towards different pathophysiological causes and preventive measures as AKI impairs short- and long-term survival.
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Affiliation(s)
- Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria;
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
- Correspondence: ; Tel.: +43-140-4005-2620
| | - Waseem Hasan
- Faculty of Medicine, Imperial College London, London SW7 2AZ, UK;
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Bernhard Winkler
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
| | - Gabriel Weiss
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
| | - Christopher Adlbrecht
- Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, 1210 Vienna, Austria; (C.A.); (G.D.-K.)
| | - Georg Delle-Karth
- Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, 1210 Vienna, Austria; (C.A.); (G.D.-K.)
| | - Martin Grabenwöger
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
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10
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Kliuk-Ben Bassat O, Finkelstein A, Bazan S, Halkin A, Herz I, Salzer Gotler D, Ravid D, Hakakian O, Keren G, Banai S, Arbel Y. Acute kidney injury after transcatheter aortic valve implantation and mortality risk-long-term follow-up. Nephrol Dial Transplant 2020; 35:433-438. [PMID: 30169857 DOI: 10.1093/ndt/gfy264] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/11/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) complicating transcatheter aortic valve implantation (TAVI) is relatively frequent and associated with significant morbidity. Previous studies have shown a higher 30-day and 1-year mortality risk in patients with periprocedural AKI. Our aim was to identify the prognostic impact of periprocedural AKI on long-term follow-up. METHODS This is a single-center prospective study evaluating patients undergoing TAVI for severe aortic stenosis. AKI was defined according to the Valve Academic Research Consortium 2 definition, as an absolute increase in serum creatinine ≥0.3 mg/dL or an increase >50% within the first week following TAVI. Mortality data were compared between patients who developed AKI and those who did not. Logistic and Cox regressions were used for survival analysis. RESULTS The final analysis included 1086 consecutive TAVI patients. AKI occurred in 201 patients (18.5%). During the follow-up period, 289 patients died. AKI was associated with an increased risk of 30-day mortality {4.5 versus 1.9% in the non-AKI group; hazard ratio [HR] 3.70 [95% confidence interval (CI) 1.35-10.13]}. Although 1-year mortality was higher in the AKI group in univariate analysis, it was not significant after a multivariate regression. AKI was a strong predictor of longer-term mortality [42.3 versus 22.7% for 7-year mortality; HR 1.71 (95% CI 1.30-2.25)]. In 189 of 201 patients we had data regarding recovery from AKI up to 30 days after discharge. In patients with recovery from AKI, the mortality rate was lower (38.2 versus 56.6% in the nonrecovery group; P = 0.022). CONCLUSIONS Periprocedural AKI following TAVI is a strong risk factor for short-term as well as long-term mortality (up to 7 years). Therefore more effort is needed to reduce this complication.
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Affiliation(s)
- Orit Kliuk-Ben Bassat
- Department of Nephrology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuel Bazan
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Halkin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Herz
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dalit Salzer Gotler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dor Ravid
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Odelia Hakakian
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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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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12
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Takada T, Jujo K, Konami Y, Otsuki H, Tanaka K, Saito C, Isomura S, Domoto S, Yamaguchi J, Niinami H, Hagiwara N. Effect of Transcatheter Aortic Valve Implantation on Renal Function in Patients With Chronic Kidney Disease. Am J Cardiol 2020; 126:82-88. [PMID: 32327190 DOI: 10.1016/j.amjcard.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) theoretically increases cardiac output and renal blood flow, and renal function (RF) recovers in patients with severe aortic valve stenosis (AS). However, procedural steps of TAVI including contrast use potentially damage RF. Data describing RF improvements after TAVI in patients with chronic kidney disease (CKD) are lacking. We aimed to determine preoperative predictors of RF improvement after TAVI in severe AS patients with CKD. This observational study included 121 consecutive patients with severe AS and CKD (grade ≥3) who underwent TAVI. The patients were grouped according to their RF improvement after TAVI that was defined as an estimated glomerular filtration rate (eGFR) increase ≥10% at discharge from their preoperative level. Sixty-five patients' (54%) RF improved after TAVI. Patients with lower preoperative eGFR tended to achieve greater eGFR increases after TAVI (r = -0.17, p = 0.059). After adjustments for the factors that were significant in the univariate analysis, the preoperative mean transaortic pressure gradient (TAPG) (adjusted odds ratio, 1.03; 95% confidence interval, 1.00 to 1.07) and E/e' (adjusted odds ratio, 0.93; 95% confidence interval, 0.88 to 0.99) independently predicted RF improvement. The cut-off values for the preoperative mean TAPG and E/e' for an RF improvement after TAVI were 47.0 mm Hg and 13.8, respectively. In conclusion, preoperatively, a high mean TAPG and a low E/e' could predict RF improvement after TAVI in patients with CKD.
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13
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Miura D, Yamada Y, Kusaba S, Nogami E, Yunoki J, Sakamoto Y, Hikichi Y, Node K, Sakaguchi Y. Influence of preoperative serum creatinine level and intraoperative volume of contrast medium on the risk of acute kidney injury after transfemoral transcatheter aortic valve implantation: a retrospective observational study. BMC Res Notes 2019; 12:484. [PMID: 31383003 PMCID: PMC6683543 DOI: 10.1186/s13104-019-4527-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to determine if contrast medium volume (CMV) is a risk factor for acute kidney injury (AKI) during transcatheter aortic valve implantation (TAVI) via a transfemoral approach performed without major complications. All TAVI procedures performed at our institution between March 2014 and March 2018 were retrospectively reviewed. AKI was diagnosed using the Acute Kidney Injury Network classification based on the Valve Academic Research Consortium-2 definition. Procedures performed via a transapical approach and those in which circulatory dynamics failed intraoperatively were excluded. Results Eighty-one (96.4%) of 100 patients scheduled for TAVI were enrolled; seven (8.6%) developed AKI and 74 (91.4%) did not. The serum creatinine (SCr) level was significantly higher (p < 0.05) and the estimated glomerular filtration rate was significantly lower in the AKI group (p < 0.05). The CMV was significantly higher in the AKI group (103 ml vs 84 ml, p < 0.05), as was the CMV × SCr/BW value (3.34 vs 1.49, p < 0.01). The area under the curve for CMV × SCr/BW was 0.9228 and the cut-off value was 2.99. The CMV, SCr, and estimated glomerular filtration rate affect the likelihood of AKI after transfemoral TAVI and a CMV × SCr/BW value > 2.99 accurately predicts AKI. Electronic supplementary material The online version of this article (10.1186/s13104-019-4527-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daisuke Miura
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan.
| | - Yasutaka Yamada
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan
| | - Shinichiro Kusaba
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan
| | - Eijiro Nogami
- Department of Thoracic and Cardiovascular Surgery, Saga University Medical Hospital, Saga, Japan
| | - Junji Yunoki
- Department of Thoracic and Cardiovascular Surgery, Saga University Medical Hospital, Saga, Japan
| | - Yoshiko Sakamoto
- Department of Cardiology, Saga University Medical Hospital, Saga, Japan
| | - Yutaka Hikichi
- Department of Cardiology, Saga University Medical Hospital, Saga, Japan
| | - Koichi Node
- Department of Cardiology, Saga University Medical Hospital, Saga, Japan
| | - Yoshiro Sakaguchi
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan
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14
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Arbel Y, Ben-Assa E, Puzhevsky D, Litmanowicz B, Galli N, Chorin E, Halkin A, Sadeh B, Konigstein M, Bassat OKB, Steinvil A, Bazan S, Banai S, Finkelstein A. Forced diuresis with matched hydration during transcatheter aortic valve implantation for Reducing Acute Kidney Injury: a randomized, sham-controlled study (REDUCE-AKI). Eur Heart J 2019; 40:3169-3178. [DOI: 10.1093/eurheartj/ehz343] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/29/2019] [Accepted: 05/08/2019] [Indexed: 12/17/2022] Open
Abstract
Abstract
Aims
Acute kidney injury (AKI) is a common complication following transcatheter aortic valve implantation (TAVI) and is associated with increased risk for short- and long-term mortality. In patients undergoing percutaneous coronary intervention (PCI), forced diuresis with matched hydration has been shown to reduce the incidence of AKI by ∼50%. The aim of the present study was to evaluate whether forced diuresis with matched intravenous hydration reduces AKI in patients undergoing TAVI.
Methods and results
Reducing Acute Kidney Injury (REDUCE-AKI) was a single-centre, prospective, randomized, double-blind sham-controlled clinical trial, designed to examine the effect of an automated matched saline infusion with urine output for the prevention of AKI in patients undergoing TAVI. A total of 136 TAVI patients were randomized, 68 in each group. Mean age was 83.9 ± 5 years and 41.2% were males. There were no differences in baseline characteristics between the two groups. The rate of AKI was not statistically different between the groups (25% in the active group vs. 19.1% in the sham group, P = 0.408). There was a significant increase in long-term mortality in the active group (27.9% vs. 13. 2% HR 3.744, 95% CI 1.51–9.28; P = 0.004). The study was terminated prematurely by the Data Safety Monitoring Board for futility and a possible signal of harm.
Conclusions
Unlike in PCI, forced diuresis with matched hydration does not prevent AKI in patients undergoing TAVI, and might be associated with increased long-term mortality. Future studies should focus on understanding the mechanisms behind these findings.
Clinicaltrials.gov registration
NCT01866800, 30 April 2013.
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Affiliation(s)
- Yaron Arbel
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Eyal Ben-Assa
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Daniela Puzhevsky
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Batia Litmanowicz
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Naama Galli
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Ehud Chorin
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Amir Halkin
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Ben Sadeh
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Maayan Konigstein
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Orit Kliuk-Ben Bassat
- Department of Nephrology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Samuel Bazan
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
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15
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Chakravarty T, Jilaihawi H, Doctor N, Fontana G, Forrester JS, Cheng W, Makkar R. Complications after Transfemoral Transcatheter Aortic Valve Replacement with a Balloon-Expandable Prosthesis: The Importance of Preventative Measures and Contingency Planning. Catheter Cardiovasc Interv 2019; 91:E29-E42. [PMID: 23436313 DOI: 10.1002/ccd.24888] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 01/11/2013] [Accepted: 02/17/2013] [Indexed: 12/19/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) with balloon-expandable Edwards-SAPIEN valve was superior to standard therapy in inoperable patients and noninferior to surgical aortic valve replacement in high surgical-risk, but operable patients, with severe symptomatic aortic stenosis in the randomized controlled PARTNER trial. Since the first case of TAVR with a balloon-expandable valve in 2002, several groups have reported their experience with balloon-expandable valves with high-procedural success. In the United States, the balloon-expandable Edwards-SAPIEN valve is the only transcatheter heart valve approved by the FDA for commercial use. Moreover, this is only in high-risk inoperable patients. Despite increasing experience with the TAVR procedure, it can be associated with complications, which can be technically challenging, even for an experienced operator. Complications associated with TAVR include vascular complications, valve malpositioning, regurgitation, embolization, coronary compromise, conduction abnormalities, stroke/transient ischemic attack, acute kidney injury, cardiac tamponade, and hemodynamic collapse. A thorough understanding of the procedure is essential for pre-emptive planning for procedural complications and early identification and management of complications are necessary for procedural success. We hereby review our experience of transfemoral TAVR with balloon-expandable valves, offer practical tips to maximize the likelihood of procedural success, describe pre-emptive strategies to prevent peri-procedural complications and bailout measures to manage them, should they occur. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Niraj Doctor
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | | | - Wen Cheng
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California
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16
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Azarbal A, Malenka DJ, Huang YL, Ross CS, Solomon RJ, DeVries JT, Flynn JM, Butzel D, McKay M, Dauerman HL. Recovery of Kidney Dysfunction After Transcatheter Aortic Valve Implantation (from the Northern New England Cardiovascular Disease Study Group). Am J Cardiol 2019; 123:426-433. [PMID: 30522749 DOI: 10.1016/j.amjcard.2018.10.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Abstract
Acute Kidney Recovery (AKR) is a potential benefit of transcatheter aortic valve implantation (TAVI). We determined the incidence and predictors of AKR in a multicenter prospective registry of TAVI. After excluding patients on dialysis or who died within 48 hours postprocedure, we reviewed 1,502 consecutive patients underwent TAVI in Northern New England from 2012 to 2017. Patients were categorized into 3 groups based on the change in postprocedure estimated glomerular filtration rate (eGFR): Acute Kidney Injury (AKI, decrease in eGFR >25%), AKR (increase in eGFR >25%) or no change in kidney function on discharge creatinine following TAVI. We then focused in patients with baseline chronic kidney disease (CKD defined as eGFR ≤60 ml/min; n = 755) and developed multivariate predictor models to determine the clinical and procedural variables associated with AKR. For the TAVI cohort (n = 1,502), the overall incidence of AKR was 17.8%. AKR was threefold higher in patients with eGFR ≤60 ml/min as compared to those with eGFR >60 ml/min (26.6% vs 8.9%, p < 0.001). In the CKD population, hospital complications were similar among patients with no change in renal function and AKR; patients with AKI had a higher rate of hospital mortality, pacemaker implantation, length of hospitalization, and transfusions. Using multivariable logistic regression, moderate to severe lung disease, eGFR < 50 ml/min and previous aortic valve surgery were found to be independent predictors of AKR. Patients with diabetes mellitus, baseline anemia, and Society of thoracic surgeons score >6.1 were less likely to develop AKR. In conclusion, AKR occurred in 1 of 4 of all TAVI patients with baseline CKD and was a more frequent phenomena than AKI. Patients with decreased lung function, previous aortic valve surgery and worse baseline renal function were more likely to demonstrate AKR, whereas patients with diabetes mellitus, baseline anemia, and higher Society of thoracic risk scores were less likely to see improvements in renal function after TAVI.
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17
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Nunes Filho AC, Katz M, Campos CM, Carvalho LA, Siqueira DA, Tumelero RT, Portella AL, Esteves V, Perin MA, Sarmento-Leite R, Lemos Neto PA, Tarasoutchi F, Bezerra HG, de Brito FS. Impacto del daño renal agudo en el seguimiento a corto y a largo plazo tras el implante percutáneo de válvula aórtica. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2017.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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18
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Ma M, Gao WD, Gu YF, Wang YS, Zhu Y, He Y. Clinical effects of acute kidney injury after transcatheter aortic valve implantation: a systematic review and meta-analysis. Intern Emerg Med 2019; 14:161-175. [PMID: 30173298 DOI: 10.1007/s11739-018-1935-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022]
Abstract
Several observational studies have shown that postoperative acute kidney injury (AKI) may significantly worsen the prognosis of a transcatheter aortic valve implantation (TAVI). The purpose of this systematic review and meta-analysis is to evaluate the recent evidence on the impact of AKI on clinical outcomes following TAVI. A comprehensive search in PubMed, Embase and the Cochrane Library was performed for relevant studies by two independent investigators. We pooled the odds ratio (OR) from individual studies, and performed heterogeneity, quality assessment and publication bias analysis. Forty-three eligible studies comprising 544,112 patients were included. Postoperative AKI not only significantly increased the risk for short-term and long-term all-cause mortality (OR 6.25, 95% CI 5.72-6.83, P < 0.00001; OR 3.49, 95% CI 2.78-4.40, P < 0.00001, respectively), but also increased the risk for early myocardial infarction (OR 3.98, 95% CI 1.90-8.31, P = 0.0002), major and life-threatening bleeding (OR 1.51, 95% CI 1.12-2.03, P = 0.007; OR 2.35, 95% CI 1.80-3.06, P < 0.00001, respectively), major vascular complications (OR 1.69, 95% CI 1.30-2.18, P < 0.0001), need for blood transfusion (OR 2.15, 95% CI 1.89-2.46, P < 0.00001) renal replacement therapy (OR 22.36, 95% CI 11.88-42.12, P = 0.0002) and cerebrovascular accidents (OR 1.92, 95% CI 1.23-2.98, P = 0.004). Acute kidney injury following TAVI is associated with increased postoperative mortality and morbidity. Future efforts are required to determine whether early prevention of post-procedural AKI after TAVI impacts upon clinical outcomes.
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Affiliation(s)
- Min Ma
- Department of Cardiology, The Sixth People's Hospital of Chengdu, Chengdu, 610051, China
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Street, Chengdu, 610041, China
| | - Wei-Dong Gao
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, 529030, Guangduo, China
| | - Yun-Fei Gu
- Department of Cardiology, LuoYang Central Hospital Affiliated to ZhengZhou University, No 288 Zhongzhou Road, Luoyang, 471000, China
| | - Yu-Shu Wang
- Department of Cardiology, The First People's Hospital of Chengdu, Chengdu, 610016, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Street, Chengdu, 610041, China
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Street, Chengdu, 610041, China.
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19
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Clinical Arterial Peripheral Vascular Pathology Does Not Impact Short- or Long-Term Survival after Transcatheter Aortic Valve Replacement. Int J Vasc Med 2018; 2018:2707421. [PMID: 30112212 PMCID: PMC6077653 DOI: 10.1155/2018/2707421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/20/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction The dramatic changes in vascular hemodynamics after transcatheter aortic valve replacement (TAVR) are well noted. However, little postprocedural data exists on the outcomes in patients with clinical arterial peripheral vascular pathology [abdominal aortic aneurysm (AAA), carotid artery stenosis (CAS), and peripheral artery disease (PAD)] undergoing TAVR for severe aortic stenosis. Setting A single center healthcare system. Methodology A retrospective chart review case-control study of 342 consecutive patients who underwent a TAVR for severe aortic stenosis at Sanford Health in Fargo; ND was performed to determine if preprocedural comorbid AAA, CAS, or PAD was associated with worse outcomes after TAVR. Results Patients with preprocedural comorbid AAA, CAS, or PAD had no significant difference overall survival at 1 month (94% versus 95% p =.812), 6 months (88% versus 89% p = .847), 1 year (74% versus 83%, p =.130), or 2 years (58% versus 63%, p =.611) after TAVR. Patients with clinical arterial peripheral vascular pathology also had no significant difference in preprocedural outcomes. Conclusion This study gives evidence to suggest that patients with a comorbid clinical peripheral arterial pathology at the time of TAVR do not have a statistically significant increase in mortality out to 2 years after TAVR and no increase in procedural complications. These results affirm the safety and feasibility of TAVR in patients with AAA, CAS, and/or PAD.
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20
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Frequency and Prognostic Significance of Acute Kidney Recovery in Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2018; 121:634-641. [PMID: 29329828 DOI: 10.1016/j.amjcard.2017.11.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 01/31/2023]
Abstract
Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is associated with increased mortality. As significant hemodynamic improvement may occur with relief of aortic stenosis, we hypothesized that TAVI patients may demonstrate the opposite phenomena: acute kidney recovery (AKR). We studied the incidence and predictors of AKR in post-TAVI patients. A total of 366 consecutive patients underwent TAVI (January 2012 to January 2017) at a single center. We defined AKR as a 25% improvement in glomerular filtration rate (GFR) at 48 hours after TAVI. AKI-creatinine (Cr) was defined as an increase in Cr of ≥0.3 mg/dl at 48 hours. Patients were categorized in 3 groups: AKR (≥25% increase in GFR), unchanged GFR, and AKI-GFR (inverse definition of AKR, ≥25% decrease in GFR). Multivariable logistic regression defined independent predictors of AKR. AKR occurred in 1/3 of patients. AKI-Cr occurred in 13% of patients, whereas AKI-GFR occurred similarly in 15%. AKR and AKI occurred most frequently in patients with chronic kidney disease (CKD: GFR ≤ 60 ml/min/1.73 m2). Independent predictors of AKR-GFR by multivariable analysis were male gender, lack of chronic β-blocker utilization, and presence of CKD. Notably, left ventricular dysfunction and contrast volume were not predictive of AKR. Transfusion occurred less frequently among patients with AKR compared with patients with AKI-GFR (11% vs 26%, p = 0.03). Death occurred in 0% of AKR patients versus 9.3% of AKI-GFR patients (p <0.01). In conclusion, this is the first report of AKR after TAVI. Patients with CKD, male gender, and lack of pre-TAVI beta blockade were more likely to demonstrate AKR.
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21
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Arsalan M, Ungchusri E, Farkas R, Johnson M, Kim RJ, Filardo G, Pollock BD, Szerlip M, Mack MJ, Holper EM. Novel renal biomarker evaluation for early detection of acute kidney injury after transcatheter aortic valve implantation. Proc (Bayl Univ Med Cent) 2018; 31:171-176. [PMID: 29706810 DOI: 10.1080/08998280.2017.1416235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/18/2017] [Indexed: 12/19/2022] Open
Abstract
Acute kidney injury (AKI) following transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The biomarkers neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) are predictive of AKI after cardiac surgery, but there is little data regarding these biomarkers after TAVI. We evaluated the associations between NGAL, KIM-1, and IL-18 levels and the incidence and severity of AKI and changes in serum creatinine after TAVI. This was a prospective pilot study of 66 TAVI cases. Urinary biomarkers were measured at baseline and at 2, 4, and 12 hours after TAVI. Demographics, procedural features, and renal function until discharge were compared between patients with and without subsequent AKI. Seventeen patients (25.8%) developed AKI postoperatively (stage 1, n = 14; stage 2, n = 1; stage 3, n = 2). There were no significant differences in unadjusted mean NGAL, KIM-1, and IL-18 levels between patients with and without AKI at 2, 4, and 12 hours following surgery. After adjusting for the Society of Thoracic Surgeons risk of mortality, this study of three urinary biomarkers showed no association with AKI or creatinine after TAVI. Ongoing efforts to predict and modify the risk of AKI after TAVI remain challenging.
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Affiliation(s)
- Mani Arsalan
- Cardiac Surgery, Kerckhoff Klinik, Bad Neuheim, Germany
| | | | | | | | - Rebeca J Kim
- Baylor Scott & White Research Institute, Plano, Texas
| | - Giovanni Filardo
- The Heart Hospital Baylor Plano, Plano, Texas.,Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas
| | - Benjamin D Pollock
- Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas
| | | | | | - Elizabeth M Holper
- Baylor Scott & White Research Institute, Plano, Texas.,The Heart Hospital Baylor Plano, Plano, Texas
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22
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Nunes Filho ACB, Katz M, Campos CM, Carvalho LA, Siqueira DA, Tumelero RT, Portella ALF, Esteves V, Perin MA, Sarmento-Leite R, Lemos Neto PA, Tarasoutchi F, Bezerra HG, de Brito FS. Impact of Acute Kidney Injury on Short- and Long-term Outcomes After Transcatheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2018; 72:21-29. [PMID: 29358043 DOI: 10.1016/j.rec.2017.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. METHODS Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. RESULTS The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). CONCLUSIONS Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI.
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Affiliation(s)
| | - Marcelo Katz
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carlos M Campos
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz A Carvalho
- Department of Interventional Cardiology, Hospital Pró-Cardíaco, Rio de Janeiro, Brazil
| | - Dimytri A Siqueira
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Rogério T Tumelero
- Department of Interventional Cardiology, Hospital São Vicente de Paulo, Passo Fundo, Brazil
| | | | - Vinícius Esteves
- Department of Interventional Cardiology, Rede D'OR São Luiz, São Paulo, Brazil
| | - Marco A Perin
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Pedro A Lemos Neto
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Flavio Tarasoutchi
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Hiram G Bezerra
- Cardiac Catheterization Laboratory, UH Cleveland Medical Center, Cleveland, United States
| | - Fábio S de Brito
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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23
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Ram P, Mezue K, Pressman G, Rangaswami J. Acute kidney injury post-transcatheter aortic valve replacement. Clin Cardiol 2017; 40:1357-1362. [PMID: 29251358 DOI: 10.1002/clc.22820] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a treatment option in high-risk patients with severe aortic stenosis who are not surgical candidates. In light of emerging evidence, it is being increasingly performed even in intermediate-risk patients in recent years. Patients who develop acute kidney injury (AKI) following TAVR are known to have worse outcomes. The objective of this concise review was to identify the prevalence and the impact of AKI following TAVR on patient outcomes by including the most recent literature in our search. After a thorough search on MEDLINE, Google Scholar, and PubMed, we included all literature relevant to AKI following TAVR. We found that AKI was caused by a variety of reasons, such as hemodynamic instability during rapid pacing, blood transfusion, periprocedural embolization, and use of contrast medium, to name a few. In patients who developed AKI following TAVR, 30-day and 1-year mortality were increased. Further, in these patients, length and cost of hospital stay were increased as well. Preventive measures such as optimal periprocedural hydration, careful contrast use, and techniques to prevent embolization during device implantation have been tried with limited success. Given that TAVR is expected to be increasingly performed, this review aimed to summarize the rapidly expanding currently available literature in an effort to reduce procedural complications and thereby improve patient outcomes.
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Affiliation(s)
- Pradhum Ram
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Kenechukwu Mezue
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Gregg Pressman
- Heart and Vascular Institute, Division of Cardiology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Janani Rangaswami
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
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24
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Ferro CJ, Law JP, Doshi SN, de Belder M, Moat N, Mamas M, Hildick-Smith D, Ludman P, Townend JN. Dialysis Following Transcatheter Aortic Valve Replacement: Risk Factors and Outcomes. JACC Cardiovasc Interv 2017; 10:2040-2047. [DOI: 10.1016/j.jcin.2017.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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25
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Jhaveri KD, Saratzis AN, Wanchoo R, Sarafidis PA. Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury. Kidney Int 2017; 91:1312-1323. [DOI: 10.1016/j.kint.2016.11.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 01/20/2023]
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26
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Liao YB, Deng XX, Meng Y, Zhao ZG, Xiong TY, Meng XJ, Zuo ZL, Li YJ, Cao JY, Xu YN, Chen M, Feng Y. Predictors and outcome of acute kidney injury after transcatheter aortic valve implantation: a systematic review and meta-analysis. EUROINTERVENTION 2017; 12:2067-2074. [DOI: 10.4244/eij-d-15-00254] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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27
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Thongprayoon C, Cheungpasitporn W, Srivali N, Kittanamongkolchai W, Greason KL, Kashani KB. Incidence and risk factors of acute kidney injury following transcatheter aortic valve replacement. Nephrology (Carlton) 2017; 21:1041-1046. [PMID: 26714182 DOI: 10.1111/nep.12704] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/20/2015] [Indexed: 12/24/2022]
Abstract
AIM This study aimed to determine the incidence and risk factors of acute kidney injury (AKI) following transcatheter aortic valve replacement (TAVR). METHODS We included all adult patients undergoing TAVR for aortic stenosis from 1 January 2008 to 30 June 2014 at a tertiary referral hospital. AKI was defined based on Kidney Disease: Improving Global Outcomes criteria. We performed a multivariate logistic regression to identify factors associated with post-procedural AKI occurrence. RESULTS Three hundred eighty-six patients met the inclusion criteria, of which 106 (28%) developed AKI. In multivariate analysis, AKI development was independently associated with a transapical approach (odds ratio (OR), 2.81; 95% confidence interval (CI), 1.72-4.65 compared with transfemoral approach) and the need for an intra-aortic balloon pump (OR, 9.11; 95% CI, 1.77-68.29). Higher baseline renal function (OR, 0.78 per 10 mL/min per 1.73 m2 increment in glomerular filtration rate; 95% CI, 0.68-0.87) was significantly associated with a decreased risk of AKI. After adjustment for the Society of Thoracic Surgeons' risk score, post-procedural AKI development remained significantly associated with an increased in-hospital (OR, 4.74; 95% CI, 1.39-18.48) and 6-month mortality (OR, 4.66; 95% CI, 2.32-9.63). CONCLUSION In a cohort of patients undergoing TAVR for aortic stenosis, AKI commonly occurred and was significantly associated with increased mortality. Baseline renal function, procedure approach and the need for circulatory support were important predictive factors for post-procedural AKI occurrence.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Narat Srivali
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kevin L Greason
- Division of Cardiovascular Surgery, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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28
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Giannini F, Latib A, Jabbour RJ, Slavich M, Benincasa S, Chieffo A, Montorfano M, Stella S, Buzzatti N, Alfieri O, Colombo A. The ratio of contrast volume to glomerular filtration rate predicts acute kidney injury and mortality after transcatheter aortic valve implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:349-355. [PMID: 28342840 DOI: 10.1016/j.carrev.2017.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to assess the impact of the ratio of volume of contrast medium to the glomerular filtration rate (V/GFR) on acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) and its impact on long-term mortality. METHODS We retrospectively calculated V/GFR in 397 patients undergoing TAVI. AKI was defined as VARC-modified Risk, Injury, Failure, Loss and End-stage (RIFLE) kidney disease score≥2. RESULTS The incidence of AKI was 17.9%. The mean V/GFR ratio was 3.0±2.7 in patients without AKI and 7.8±8.8 in patients with AKI (p<0.001). The receiver-operator characteristic curve analysis showed fair discrimination between patients with and without AKI (C-statistic 0.85) at a V/GFR ratio of 3.2. Multivariable regression analysis indicated that V/GFR>3.2 was an independent predictor of both AKI (OR 3.4, 95% CI 1.0-6.1, p<0.001) and long-term mortality (OR 3.3, 95% CI 2.0-5.2, p<0.001). CONCLUSIONS A V/GFR > 3.2 was found to be correlated with a higher incidence of AKI and mortality after TAVI. Therefore, this ratio could potentially be used to calculate the maximum volume of contrast medium that can be administered without significantly increasing the risk of AKI and mortality. Further larger studies are needed to validate these findings.
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Affiliation(s)
- Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Richard J Jabbour
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Slavich
- Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Susanna Benincasa
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiothoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiothoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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29
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James Rodriguez R, Prasad A. Transcatheter aortic valve replacement and renal function: A complex relationship. Catheter Cardiovasc Interv 2017; 89:460-461. [PMID: 28220650 DOI: 10.1002/ccd.26942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Ruben James Rodriguez
- Department of Medicine, Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Anand Prasad
- Department of Medicine, Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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30
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Affiliation(s)
- Pedro A Villablanca
- Division of Cardiovascular Diseases Montefiore Medical Center/Albert Einstein College of Medicine New York, NY
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology Mayo Clinic College of Medicine Scottsdale, AZ
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31
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Schewel D, Zavareh M, Schewel J, Thielsen T, Schmidt T, Schäfer U, Kuck KH, Frerker C. Impact of interaction of diabetes mellitus and impaired renal function on prognosis and the incidence of acute kidney injury in patients undergoing transcatheter aortic valve replacement (TAVR). Int J Cardiol 2017; 232:147-154. [PMID: 28089458 DOI: 10.1016/j.ijcard.2017.01.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/17/2016] [Accepted: 01/04/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND In high-risk patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) diabetes mellitus (DM) is a common comorbidity. It is known to increase the risk of arteriosclerosis and adversely affect morbidity, mortality for all types of cardiovascular disease, and post-procedural outcome after percutaneous and surgical procedures. Moreover, DM is known to facilitate the genesis of renal failure (RF). Pre-existing RF seems to increase the rate of acute kidney injury (AKI), which is a powerful short- and midterm predictor of mortality in patients undergoing TAVR. Therefore, the aim of the present study was to investigate the impact of DM on AKI, short- and midterm prognosis after TAVR, especially in patients with pre-existing RF. METHODS AND RESULTS In 337(30%) of 1109 patients DM was documented. The incidence of RF at baseline (GFR <60mL/min) was statistically similar in both patient groups (no DM vs. DM: 54% vs. 61%; p=0.057). Also, the incidence of AKI stage 3 was similar in all patients (no DM vs. DM: 1.6% vs. 1.8%; p=0.799). There were no significant differences regarding the procedure-related complications according to VARC-2 and mortality between patients neither with nor without DM. Even after differentiating patients according to baseline renal function, similar incidence of AKI and midterm mortality were documented. CONCLUSION In patients undergoing TAVR, neither in case of preserved nor impaired renal function, we couldn't find any evidence for influence of DM on overall acute and midterm prognosis nor the incidence of AKI.
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Affiliation(s)
- Dimitry Schewel
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany.
| | - Milad Zavareh
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Jury Schewel
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Thomas Thielsen
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Tobias Schmidt
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Christian Frerker
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
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32
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Wang J, Yu W, Zhou Y, Yang Y, Li C, Liu N, Hou X, Wang L. Independent Risk Factors Contributing to Acute Kidney Injury According to Updated Valve Academic Research Consortium-2 Criteria After Transcatheter Aortic Valve Implantation: A Meta-analysis and Meta-regression of 13 Studies. J Cardiothorac Vasc Anesth 2016; 31:816-826. [PMID: 28385646 DOI: 10.1053/j.jvca.2016.12.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to examine the risk factors for transcatheter aortic valve implantation (TAVI)-associated acute kidney injury (AKI) according to the AKI definition from the Valve Academic Research Consortium-2 (VARC-2). SETTING A meta-analysis. PARTICIPANTS A total of 661 patients with post-TAVI AKI according to the VARC-2 definition and 2,012 controls were included in the meta-analysis. INTERVENTIONS Patients undergoing TAVI were included in this meta-analysis. MEASUREMENTS AND MAIN RESULTS Multiple electronic databases were searched using predefined criteria. The diagnosis of AKI was based on the VARC-2 classification. The authors found that preoperative New York Heart Association class IV (odds ratio [OR], 7.77; 95% confidence interval [CI], 3.81-15.85), previous chronic renal disease (CKD) (OR, 2.81; 95% CI, 1.96-4.03), and requirement for transfusion (OR, 2.03; 95% CI, 1.59-2.59) were associated significantly with an increased risk for post-TAVI AKI. Furthermore, previous peripheral vascular disease (PVD), hypertension, atrial fibrillation, congestive heart failure, diabetes mellitus, and stroke were also risk factors for TAVI-associated AKI. Additionally, transfemoral access significantly correlated with a reduced risk for post-TAVI AKI (OR, 0.43; 95% CI, 0.33-0.57). The potential confounders, including Society of Thoracic Surgeons Score, the logistic European System for Cardiac Operative Risk Evaluation, aortic valve area, mean pressure gradient, left ventricular ejection fraction, age, body mass index, contrast volume, and valve type, had no impact on the association between the risk factors and post-TAVI AKI. Subgroup analysis of the eligible studies presenting multivariate logistic regression analysis on the independent risk factors for post-TAVI AKI revealed that previous CKD, previous PVD, and transapical access were independent risk factors for TAVI-associated AKI. CONCLUSIONS The current meta-analysis suggested that previous CKD, previous PVD, and transapical access may be independent risk factors for TAVI-associated AKI.
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Affiliation(s)
- Jiayang Wang
- Department of Cardiac Surgery, Beijing An Zhen Hospital Capital Medical University, Beijing, China; Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Wenyuan Yu
- Department of Cardiac Surgery, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Ye Zhou
- Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Yong Yang
- Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Chenglong Li
- Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Nan Liu
- Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China.
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Longfei Wang
- Department of Cardiac Surgery, Beijing An Zhen Hospital Capital Medical University, Beijing, China
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33
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Villablanca PA, Mathew V, Thourani VH, Rodés-Cabau J, Bangalore S, Makkiya M, Vlismas P, Briceno DF, Slovut DP, Taub CC, McCarthy PM, Augoustides JG, Ramakrishna H. A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis. Int J Cardiol 2016; 225:234-243. [DOI: 10.1016/j.ijcard.2016.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/04/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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34
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Meneguz-Moreno RA, Ramos AIO, Siqueira D, de Castro-Filho A, Jatene T, Dias Jeronimo A, Le Bihan D, Moreira A, Arrais M, Abizaid A, Sousa A, Eduardo Sousa J. Prognostic value of renal function in patients with aortic stenosis treated with transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2016; 89:452-459. [DOI: 10.1002/ccd.26693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - Dimytri Siqueira
- Instituto Dante Pazzanese de Cardiologia; São Paulo Brazil
- Hospital do Coração; São Paulo Brazil
| | | | - Tannas Jatene
- Instituto Dante Pazzanese de Cardiologia; São Paulo Brazil
| | | | - David Le Bihan
- Instituto Dante Pazzanese de Cardiologia; São Paulo Brazil
| | | | - Magaly Arrais
- Instituto Dante Pazzanese de Cardiologia; São Paulo Brazil
- Hospital do Coração; São Paulo Brazil
| | - Alexandre Abizaid
- Instituto Dante Pazzanese de Cardiologia; São Paulo Brazil
- Hospital do Coração; São Paulo Brazil
| | - Amanda Sousa
- Instituto Dante Pazzanese de Cardiologia; São Paulo Brazil
- Hospital do Coração; São Paulo Brazil
| | - J. Eduardo Sousa
- Instituto Dante Pazzanese de Cardiologia; São Paulo Brazil
- Hospital do Coração; São Paulo Brazil
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35
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Giannini F, Latib A, Jabbour RJ, Ruparelia N, Aurelio A, Ancona MB, Figini F, Mangieri A, Regazzoli D, Tanaka A, Montalto C, Azzalini L, Monaco F, Agricola E, Chieffo A, Montorfano M, Alfieri O, Colombo A. Impact of post-procedural hyperglycemia on acute kidney injury after transcatheter aortic valve implantation. Int J Cardiol 2016; 221:892-7. [PMID: 27434367 DOI: 10.1016/j.ijcard.2016.07.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Post-operative hyperglycemia, in individuals with and without diabetes, has been identified as a predictor of acute kidney injury (AKI) in patients following cardiac surgery. Whether or not this is also true for patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. OBJECTIVES To evaluate whether post-procedural glucose levels are associated with AKI after TAVI. METHODS AND RESULTS A total of 422 consecutive patients undergoing transfemoral TAVI were included in the analysis. For each patient, plasma glucose levels were assessed at hospital admission, 4h after the procedure and daily during hospitalization. Post-procedural hyperglycemia was defined as 2 consecutive blood glucose readings ≥150mg/dL in the 72-hour period following TAVI. AKI was defined according to the VARC consensus report regarding standardized endpoint definitions. Overall, 137 (32.5%) patients developed post-procedural hyperglycemia and 138 (33%) patients developed AKI. Hyperglycemia was associated with a 2-fold higher incidence of AKI than in patients without hyperglycemia (48% vs. 25%, p<0.001). In-hospital mortality was higher in patients with hyperglycemia than in those without hyperglycemia (9.6% vs. 1.8%, p<0.001). In-hospital mortality rate was also higher in patients who developed AKI (12.7% vs. 2.7%, p<0.001). Patients with acute hyperglycemia that developed AKI had the highest in-hospital and long-term mortality rate (15% and 38%). Post-procedural hyperglycemia was an independent predictor of AKI. CONCLUSIONS Post-procedural hyperglycemia is associated with a higher incidence of AKI and mortality after TAVI. Randomized controlled trials are needed to determine whether meticulous post-procedural glycemic control following TAVI impacts upon clinical outcomes.
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Affiliation(s)
- Francesco Giannini
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy.
| | - Azeem Latib
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Richard J Jabbour
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy; Imperial College London, UK
| | - Neil Ruparelia
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Andrea Aurelio
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | - Filippo Figini
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | | | | | - Akihito Tanaka
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy
| | | | | | - Fabrizio Monaco
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | | | - Alaide Chieffo
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy
| | | | | | - Antonio Colombo
- Interventional Cardiology, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy
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Thongprayoon C, Cheungpasitporn W, Gillaspie EA, Greason KL, Kashani KB. The risk of acute kidney injury following transapical versus transfemoral transcatheter aortic valve replacement: a systematic review and meta-analysis. Clin Kidney J 2016; 9:560-6. [PMID: 27478597 PMCID: PMC4957730 DOI: 10.1093/ckj/sfw055] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/13/2016] [Indexed: 01/11/2023] Open
Abstract
Background The aim of this systematic review is to examine the literature for the risk of acute kidney injury (AKI) in patients who underwent transcatheter aortic valve replacement (TAVR) based on transapical (TA) versus transfemoral (TF) approaches. Methods A literature search was conducted utilizing Embase, Medline, Cochrane Database of Systematic Reviews and ClinicalTrials.gov from inception through December 2015. Studies that reported relative risk, odds ratio or hazard ratio comparing the AKI risk in patients who underwent TA-TAVR versus TF-TAVR were included. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random effect, generic inverse variance method. Results Seventeen cohort studies with 5085 patients were enrolled in the analysis to assess the risk of AKI in patients undergoing TA-TAVR versus TF-TAVR. The pooled RR of AKI in patients who underwent TA-TAVR was 2.26 (95% CI 1.79–2.86) when compared with TF-TAVR. When meta-analysis was confined to the studies with adjusted analysis for confounders evaluating the risk of AKI following TAVR, the pooled RR of TA-TAVR was 2.89 (95% CI 2.12–3.94). The risk for moderate to severe AKI [RR 1.02 (95% CI 0.57–1.80)] in patients who underwent TA-TAVR compared with TF-TAVR was not significantly higher. Conclusions Our meta-analysis demonstrates an association between TA-TAVR and a higher risk of AKI. Future studies are required to assess the risks of moderate to severe AKI and mortality following TA-TAVR versus TF-TAVR.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension , Mayo Clinic , 200 First Street SW, Rochester, MN 55905 , USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension , Mayo Clinic , 200 First Street SW, Rochester, MN 55905 , USA
| | - Erin A Gillaspie
- Division of Cardiovascular Surgery, Department of Surgery , Mayo Clinic , Rochester, MN , USA
| | - Kevin L Greason
- Division of Cardiovascular Surgery, Department of Surgery , Mayo Clinic , Rochester, MN , USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Bona V, Khawaja MZ, Bapat V, Young C, Hancock J, Redwood S, Fusari M, Thomas M. Early and late changes in quality of life following transcatheter aortic valve implantation using the transfemoral and transapical approaches. EUROINTERVENTION 2016; 11:221-9. [PMID: 24769484 DOI: 10.4244/eijv11i2a41] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To evaluate the effects of access route upon clinical results and quality of life (QoL) in patients undergoing either transfemoral (TF-TAVI) or transapical balloon-expandable transcatheter aortic valve implantation (TA-TAVI) in the real world. METHODS AND RESULTS A prospective analysis was performed upon 264 consecutive patients receiving TF-TAVI or TA-TAVI. QoL was assessed using the EQ-5D questionnaire. At baseline, TA-TAVI patients reported significantly more problems in mobility, self-care, usual activities and lower overall health status domains (p<0.01 for all). At 30 days, the TF-TAVI group reported fewer problems with usual activity (p=0.01) and pain/discomfort (p<0.01), and higher EQ-5D index and visual analogue scale (VAS) (p=0.01 and p<0.01, respectively) than the TA-TAVI group. Nevertheless, the absolute improvements (ΔEQ-5D index and ΔEQ-5D VAS) were larger in the TA-TAVI group, with most dramatically marked QoL absolute improvements (p<0.01 and p=0.02, respectively). By one year, notwithstanding higher all-cause mortality in the sicker TA-TAVI group, there were no differences between groups in any EQ-5D domain. Indeed, surviving TA-TAVI group's greater absolute improvements remained (p<0.01). CONCLUSIONS QoL is greater at the earlier time point of 30 days in the TF-TAVI cohort but equatable by one year. However, the magnitude of improvement in QoL is greater in the TA-TAVI patients at both 30 days and one year.
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Affiliation(s)
- Veronica Bona
- Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Cheungpasitporn W, Thongprayoon C, Kashani K. Transcatheter Aortic Valve Replacement: a Kidney's Perspective. J Renal Inj Prev 2016; 5:1-7. [PMID: 27069960 PMCID: PMC4827378 DOI: 10.15171/jrip.2016.01] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/05/2016] [Indexed: 12/24/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has now emerged as a viable treatment option for high-risk patients with severe aortic stenosis (AS) who are not suitable candidates for surgical aortic valve replacement (SAVR). Despite encouraging published outcomes, acute kidney injury (AKI) is common and lowers the survival of patients after TAVR. The pathogenesis of AKI after TAVR is multifactorial including TAVR specific factors such as the use of contrast agents, hypotension during rapid pacing, and embolization; preventive measures may include pre-procedural hydration, limitation of contrast dye exposure, and avoidance of intraprocedural hypotension. In recent years, the number of TAVR performed worldwide has been increasing, as well as published data on renal perspectives of TAVR including AKI, chronic kidney disease, end-stage kidney disease, and kidney transplantation. This review aims to present the current literature on the nephrology aspects of TAVR, ultimately to improve the patients' quality of care and outcomes.
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Affiliation(s)
- Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Kianoush Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Barbanti M, Gulino S, Capranzano P, Immè S, Sgroi C, Tamburino C, Ohno Y, Attizzani GF, Patanè M, Sicuso R, Pilato G, Di Landro A, Todaro D, Di Simone E, Picci A, Giannetto G, Costa G, Deste W, Giannazzo D, Grasso C, Capodanno D, Tamburino C. Acute Kidney Injury With the RenalGuard System in Patients Undergoing Transcatheter Aortic Valve Replacement: The PROTECT-TAVI Trial (PROphylactic effecT of furosEmide-induCed diuresis with matched isotonic intravenous hydraTion in Transcatheter Aortic Valve Implantation). JACC Cardiovasc Interv 2015; 8:1595-604. [PMID: 26386766 DOI: 10.1016/j.jcin.2015.07.012] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/09/2015] [Accepted: 07/16/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the effect of the RenalGuard System (PLC Medical Systems, Milford, Massachusetts) on prevention of acute kidney injury (AKI) in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND TAVR is associated with varying degrees of post-procedural AKI. The RenalGuard System is a dedicated device designed for contrast-induced AKI prevention. Whether this device is also effective in patients with severe aortic stenosis undergoing TAVR is unexplored. METHODS The present is an investigator-driven, single-center, prospective, open-label, registry-based randomized study that used the TAVR institutional registry of the Ferrarotto Hospital in Catania, Italy, as the platform for randomization, data collection, and follow-up assessment. A total of 112 consecutive patients undergoing TAVR were randomly assigned to hydration with normal saline solution controlled by the RenalGuard system and furosemide (RenalGuard group) or normal saline solution (control group). The primary endpoint was the incidence of Valve Academic Research Consortium-defined AKI in the first 72 h after the procedure. RESULTS The AKI rate was lower in the RenalGuard group than in the control group (n = 3 [5.4%] vs. n =14 [25.0%], respectively, p = 0.014). The majority of patients (5.4% vs. 23.2%) developed a mild AKI (stage 1); severe damage (stage 3) occurred only in 1 patient in the control group (0.0% vs. 1.8%). No case of in-hospital renal failure requiring dialysis was reported. No significant differences in terms of mortality, cerebrovascular events, bleeding, and hospitalization for heart failure were noted in both groups at 30 days. CONCLUSIONS Furosemide-induced diuresis with matched isotonic intravenous hydration using the RenalGuard system is an effective therapeutic tool to reduce the occurrence of AKI in patients undergoing TAVR.
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Affiliation(s)
- Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
| | - Simona Gulino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Piera Capranzano
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Sebastiano Immè
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Carmelo Sgroi
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Claudia Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Yohei Ohno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Department of Cardiology, University of Tokai, School of Medicine, Isehara, Japan
| | - Guilherme F Attizzani
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; The Valve & Structural Heart Disease Intervention Center, Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
| | - Martina Patanè
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Rita Sicuso
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Gerlando Pilato
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Alessio Di Landro
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Denise Todaro
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Emanuela Di Simone
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Andrea Picci
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giuliana Giannetto
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Wanda Deste
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Daniela Giannazzo
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Carmelo Grasso
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; ETNA Foundation, Catania, Italy
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Koifman E, Segev A, Fefer P, Barbash I, Sabbag A, Medvedovsky D, Spiegelstein D, Hamdan A, Hay I, Raanani E, Goldenberg I, Guetta V. Comparison of acute kidney injury classifications in patients undergoing transcatheter aortic valve implantation: Predictors and long-term outcomes. Catheter Cardiovasc Interv 2015; 87:523-31. [DOI: 10.1002/ccd.26138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 05/05/2015] [Accepted: 07/12/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Edward Koifman
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
| | - Amit Segev
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
| | - Paul Fefer
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
| | - Israel Barbash
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
| | - Avi Sabbag
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
| | - Diego Medvedovsky
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
| | - Dan Spiegelstein
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
| | - Ashraf Hamdan
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
| | - Ilan Hay
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
| | - Ehud Raanani
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
| | - Victor Guetta
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer; Israel
- Sackler School of Medicine, Tel Aviv University; Israel
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Khawaja MZ, Redwood SR, Thomas M. Coronary artery disease in patients undergoing TAVI--why not to treat. EUROINTERVENTION 2015; 10 Suppl U:U76-83. [PMID: 25256336 DOI: 10.4244/eijv10sua11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The management of coronary artery disease in the context of severe aortic stenosis in patients at increased surgical risk is an increasingly relevant problem in the transcatheter aortic valve implantation (TAVI) era. We review the current data on percutaneous coronary intervention (PCI) in TAVI patients and discuss how it has impacted upon our decision making, advocating that pre-TAVI revascularisation is not necessarily required.
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Affiliation(s)
- Muhammed Z Khawaja
- King's College London, British Heart Foundation Centre of Research Excellence, Cardiovascular Division, The Rayne Institute, London, United Kingdom
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Rahman MS, Sharma R, Brecker SJ. Transcatheter aortic valve implantation in patients with pre-existing chronic kidney disease. IJC HEART & VASCULATURE 2015; 8:9-18. [PMID: 28785672 PMCID: PMC5497245 DOI: 10.1016/j.ijcha.2015.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 04/16/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND We investigated the effect of chronic kidney disease (CKD) on morbidity and mortality following transcatheter aortic valve implantation (TAVI) including patients on haemodialysis, often excluded from randomised trials. METHODS AND RESULTS We performed a retrospective post hoc analysis of all patients undergoing TAVI at our centre between 2008 and 2012. 118 consecutive patients underwent TAVI; 63 were considered as having (CKD) and 55 not having (No-CKD) significant pre-existing CKD, (defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2). Chronic haemodialysis patients (n = 4) were excluded from acute kidney injury (AKI) analysis. Following TAVI, in CKD and No-CKD patients respectively, AKI occurred in 23.7% and 14.5% (p = 0.455) and renal replacement therapy (RRT) was necessary in 8.5% and 3.6% (relative risk (RR) [95% CI] = 2.33 [0.47-11.5], p = 0.440); 30-day mortality rates were 6.3% and 1.8% (p = 0.370); and 1-year mortality rates were 17.5% and 18.2% (p = 0.919). Patients who developed AKI had a significantly increased risk of 30-day (12.5% vs. 1.1%, p = 0.029) mortality. We found the presence of diabetes (odds ratio (OR) [95% CI] = 4.58 [1.58-13.3], p = 0.005) and elevated baseline serum creatinine (OR [95% CI] = 1.02 [1.00-1.03], p = 0.026) to independently predict AKI to statistical significance by multivariate analysis. CONCLUSION TAVI is a safe, acceptable treatment for patients with pre-existing CKD, however caution must be exercised, particularly in patients with pre-existing diabetes mellitus and elevated pre-operative serum creatinine levels as this confers a greater risk of AKI development, which is associated with increased short-term post-operative mortality.
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Affiliation(s)
- Mohammed Shamim Rahman
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK
- Department of Cardiology and Cardiothoracic Surgery, St George's Hospital, London, UK
- Corresponding author at: Imperial College London, Room 5N1 Commonwealth Building, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK. Tel.: + 44 20 3313 2214; fax: + 44 20 8383 2062.
| | - Rajan Sharma
- Department of Cardiology and Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Stephen J.D. Brecker
- Department of Cardiology and Cardiothoracic Surgery, St George's Hospital, London, UK
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Conradi L, Schaefer A, Seiffert M, Schirmer J, Schaefer U, Schön G, Blankenberg S, Reichenspurner H, Treede H, Diemert P. Transfemoral TAVI without pre-dilatation using balloon-expandable devices: a case-matched analysis. Clin Res Cardiol 2015; 104:735-42. [DOI: 10.1007/s00392-015-0836-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/24/2015] [Indexed: 01/10/2023]
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Gargiulo G, Sannino A, Capodanno D, Perrino C, Capranzano P, Barbanti M, Stabile E, Trimarco B, Tamburino C, Esposito G. Impact of postoperative acute kidney injury on clinical outcomes after transcatheter aortic valve implantation: A meta-analysis of 5,971 patients. Catheter Cardiovasc Interv 2015; 86:518-27. [PMID: 25641565 DOI: 10.1002/ccd.25867] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/25/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is conflicting evidence on the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with postoperative acute kidney injury (AKI). Therefore, we conducted a meta-analysis on the impact of AKI on clinical outcomes after TAVI. METHODS AND RESULTS Twenty-four studies including 5,971 patients were analyzed. The mean incidence of AKI in this population was 22.1% ± 11.2. Postoperative AKI significantly increased early (odds ratio [OR] 5.09; 95% confidence interval [CI], 4.03-6.43 and OR 6.14; 95% CI, 3.26-11.55) and 1-year (OR 3.27; 95% CI, 2.42-4.42 and OR 1.93; 95% CI, 1.38-2.71) all-cause and cardiovascular mortality respectively, but also early myocardial infarction (OR 3.30; 95% CI, 1.44-7.57), life-threatening bleeding (OR 2.90; 95% CI, 1.67-5.05), need for transfusion (OR 2.42; 95% CI, 1.96-2.99), and dialysis (OR 14.35; 95% CI, 6.21-33.20), with a non-significant increase of stroke (OR 1.66; 95% CI, 0.94-2.95), hospitalization (mean difference [MD] 1.73; 95% CI, -0.31 to 3.77) and contrast medium received (MD 4.74; 95% CI, -2.33 to 11.81). CONCLUSIONS Postoperative AKI seems to significantly worsen TAVI prognosis. The results of the present meta-analysis should be considered hypothesis-generating and future studies on risk stratification, prevention, and postoperative management are needed.
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Affiliation(s)
- Giuseppe Gargiulo
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Anna Sannino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.,Excellence through Newest Advances (ETNA) Foundation, Catania, Italy
| | - Cinzia Perrino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Piera Capranzano
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.,Excellence through Newest Advances (ETNA) Foundation, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Bruno Trimarco
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.,Excellence through Newest Advances (ETNA) Foundation, Catania, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Najjar M, Salna M, George I. Acute kidney injury after aortic valve replacement: incidence, risk factors and outcomes. Expert Rev Cardiovasc Ther 2015; 13:301-16. [PMID: 25592763 DOI: 10.1586/14779072.2015.1002467] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The occurrence of acute kidney injury (AKI) following aortic valve replacement (AVR) has very serious clinical implications and has therefore been the focus of several studies. The authors report the results of previous studies evaluating both transcatheter AVR (TAVR) and indirectly surgical AVR (SAVR) through looking at cardiopulmonary bypass (CPB) cardiac surgeries, and identify the incidence, predictors and outcomes of AKI following AVR. In most studies, AKI was defined using the Risk, Injury, Failure, Loss and End Stage, Valve Academic Research Consortium (modified Risk, Injury, Failure, Loss and End Stage) or Valve Academic Research Consortium-2 (Acute Kidney Injury Network) AKI classification criteria. Twelve studies including more than 90,000 patients undergoing cardiac surgery on CPB were considered as well as 26 studies with more than 6000 patients undergoing TAVR. Depending on the definition used, AKI occurred in 3.4-43% of SAVR cases with up to 2.5% requiring dialysis, and in 3.4-57% of TAVR cases. Factors identified as independent predictors of AKI were: baseline kidney failure, EUROSCORE, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, anemia, peripheral vascular disease, heart failure, surgical priority, CPB time, reoperation, use of intra-aortic balloon pump, need for re-exploration, contrast agent volume, transapical access, blood transfusion, postoperative thrombocytopenia, postoperative leukocytosis as well as demographic variables such as age and female gender. The 30-day mortality rate for patients with AKI following SAVR ranged from 5.5 to 46% and was 3- to 16-times higher than in those without AKI. Similarly, patients who developed AKI after TAVR had a mortality rate of 7.8-29%, which was two- to eight-times higher than those who did not suffer from AKI. AKI confers up to a fourfold increase in 1-year mortality. Finally, hospital length of stay was significantly increased in patients with AKI in both SAVR and TAVR groups, with increases up to 3- and 2.5-times, respectively.
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Affiliation(s)
- Marc Najjar
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University - New York Presbyterian Hospital, MHB 7GN-435, 177 Fort Washington Ave, New York, NY 10032, USA
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Barbanti M, Latib A, Sgroi C, Fiorina C, De Carlo M, Bedogni F, De Marco F, Ettori F, Petronio AS, Colombo A, Testa L, Klugmann S, Poli A, Maffeo D, Maisano F, Aruta P, Gulino S, Giarratana A, Patanè M, Cannata S, Immè S, Mangoni L, Rossi A, Tamburino C. Acute kidney injury after transcatheter aortic valve implantation with self-expanding CoreValve prosthesis: results from a large multicentre Italian research project. EUROINTERVENTION 2015; 10:133-40. [PMID: 24213329 DOI: 10.4244/eijv10i1a20] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Transcatheter aortic valve implantation (TAVI) can be associated with varying degrees of new renal impairment. The aim of this multicentre analysis was to determine the impact and predictors of periprocedural acute kidney injury (AKI) on prognosis after TAVI. METHODS AND RESULTS From the ClinicalService (a nation-based data repository and medical care project) dataset, 1,157 patients with severe aortic stenosis treated with the third-generation CoreValve prosthesis in seven Italian sites, and with creatinine data available at baseline and during the post-TAVI in-hospital course, were included in this analysis. All outcomes were defined according to the VARC criteria. Overall, AKI occurred in 231 (20.0%): 15.4% stage 1, 2.7% stage 2, and 1.9% stage 3. Compared to patients without AKI, patients who suffered post-procedural AKI had significantly higher three-year all-cause mortality (31% vs. 12%; adjusted HR: 2.09; 95% CI: 1.52-2.87, p<0.001) and cardiovascular mortality (14% vs. 6%; adjusted HR: 2.28; 95% CI: 1.41-3.71, p=0.001). No significant differences in terms of stroke, spontaneous MI, and bleeding were reported. Female gender (adjusted OR: 1.37, 95% CI: 1.01-1.87; p=0.045), baseline renal insufficiency (adjusted OR: 11.02, 95% CI: 5.12-23.73; p<0.001), general anaesthesia (adjusted OR: 1.37, 95% CI: 1.00-1.87; p=0.050), and transfusion ≥3 red blood cell (RBC) units within 72 hrs from TAVI (adjusted OR: 1.65, 95% CI: 1.02-2.68; p=0.041) were found to be independent predictors of AKI. CONCLUSIONS Acute kidney injury is a frequent complication and significantly impacts on both early and long-term TAVI survival. Females, subjects with impaired renal function at baseline, patients undergoing TAVI under general anaesthesia, and patients receiving ≥3 RBC units after the procedure should be considered populations at high risk for the development of AKI after TAVI.
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Affiliation(s)
- Marco Barbanti
- Ferrarotto Hospital, University of Catania, Catania, Italy
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Periprocedural Bleeding, Acute Kidney Injury, and Long-term Mortality After Transcatheter Aortic Valve Implantation. Can J Cardiol 2015; 31:56-62. [DOI: 10.1016/j.cjca.2014.11.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 12/28/2022] Open
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Muñoz-García AJ, Muñoz-García E, Jiménez-Navarro MF, Domínguez-Franco AJ, Alonso-Briales JH, Hernández-García JM, de Teresa-Galván E. Clinical impact of acute kidney injury on short- and long-term outcomes after transcatheter aortic valve implantation with the CoreValve prosthesis. J Cardiol 2014; 66:46-9. [PMID: 25454207 DOI: 10.1016/j.jjcc.2014.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/15/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) after cardiac surgery is associated with increased mortality, but few data exist on the occurrence and clinical impact of AKI associated with transcatheter aortic valve implantation (TAVI). The objective of this study was to determine the incidence and prognosis of AKI after percutaneous implantation of the CoreValve(®) (Medtronic, Minneapolis, MN, USA) prosthesis. METHODS A total of 357 patients with severe aortic stenosis and 9 patients with pure native aortic regurgitation were treated with the CoreValve prosthesis. AKI was defined according to Valve Academic Research Consortium criteria as the absolute increase in serum creatinine ≥0.3mg/dl at 72h post percutaneous procedure. RESULTS AKI was identified in 58 patients (15.8%), none of whom required renal replacement therapy. In patients with AKI, the mortality at 30 days was 13.5% compared with 1.6% of patients without AKI, [odds ratio (OR)=12.2 (95% CI 3.53-41.9); p<0.001] and total mortality after a mean of 26.2±17 months was 29.3% vs. 14.9% [OR=2.36 (95% CI 1.23-4.51), p=0.008]. In the multivariate analysis, AKI was an independent predictor of cumulative total mortality [hazard ratio=2.151, (95% CI from 1.169 to 3.957), p=0.014]. CONCLUSIONS The deterioration of renal function in patients undergoing TAVI with the CoreValve prosthesis is a serious and frequent complication. The occurrence of AKI was associated with increased early mortality and was also a predictor of worse outcomes in follow-up.
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Affiliation(s)
- Antonio J Muñoz-García
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain.
| | - Erika Muñoz-García
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
| | - Manuel F Jiménez-Navarro
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
| | - Antonio J Domínguez-Franco
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
| | - Juan H Alonso-Briales
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
| | - José M Hernández-García
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
| | - Eduardo de Teresa-Galván
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
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