Transcatheter Aortic Valve Implantation in Patients with Pre-existing Chronic Kidney Disease

Overview

Journal Int J Cardiol Heart Vasc

Date 2017 Aug 9

PMID 28785672

Citations 5

Authors

Mohammed Shamim Rahman

Rajan Sharma

Stephen J D Brecker

Affiliations

Soon will be listed here.

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 m). 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% ( = 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], = 0.440); 30-day mortality rates were 6.3% and 1.8% ( = 0.370); and 1-year mortality rates were 17.5% and 18.2% ( = 0.919). Patients who developed AKI had a significantly increased risk of 30-day (12.5% vs. 1.1%, = 0.029) mortality. We found the presence of diabetes (odds ratio (OR) [95% CI] = 4.58 [1.58-13.3], = 0.005) and elevated baseline serum creatinine (OR [95% CI] = 1.02 [1.00-1.03], = 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.

Citing Articles

Transcatheter aortic valve replacement in patients with chronic kidney disease: a multi-centre retrospective study.

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Comparative Analysis of TAVR (Transcatheter Aortic Valve Replacement) and Surgical Valve Replacement for Low-Risk Patients.

Topalkatti U, Prasad R, Koppu B, Reddy K, Mekala S, Banothu R Cureus. 2023; 15(10):e47234.

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Five-Year Follow-Up After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease: A Single-Center Experience.

Abawi A, Magnuson A, Frobert O, Samano N Braz J Cardiovasc Surg. 2023; 39(1):e20220461.

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Impact of Chronic Kidney Disease on the Prognosis of Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis: A Meta-Analysis of 133624 Patients.

Wang J, Liu S, Han X, Chen Y, Chen H, Dong S Ann Thorac Cardiovasc Surg. 2021; 28(2):83-95.

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Role of coronary angiogram before transcatheter aortic valve implantation.

Beska B, Manoharan D, Mohammed A, Das R, Edwards R, Zaman A World J Cardiol. 2021; 13(8):361-371.

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