Zero-contrast Imaging for the Assessment of Transcatheter Aortic Valve Implantation in Candidates with Renal Dysfunction

Overview

Journal Ren Fail

Publisher Informa Healthcare

Date 2023 Jun 23

PMID 37350345

Authors

Guy F A Prado

Stefano Garzon

Jose Mariani

Adriano Caixeta

Breno O Almeida

Felipe O Ramalho

Marcelo L C Vieira

Claudio H Fischer

Gilberto Szarf

Walther Ishikawa

Pedro A Lemos

Affiliations

Soon will be listed here.

Abstract

Background: Candidates for transcatheter aortic valve implantation (TAVI) are currently evaluated using computed tomography angiography and invasive cardiac catheterization as an essential part of case selection and pre-procedure interventional planning. However, both imaging methods utilize iodinated agents, which may cause contrast-induced nephropathy, particularly in patients with baseline renal dysfunction. This study aimed to describe a zero-contrast imaging protocol for pre-TAVI evaluation in patients with advanced renal impairment.

Methods: The pre-TAVI zero-contrast scheme consisted of the following multi-modality combinations: (1) gadolinium-free magnetic resonance imaging (three-dimensional navigator-echo with electrocardiogram-gated steady-state free-precession series); (2) iodinated-free multislice computed tomography electrocardiogram-gated; (3) lower limb arterial duplex scan ultrasound; and (4) transesophageal echocardiography. Ultimately, TAVI was performed for those deemed good candidates, and contrast was allowed during the intervention; however, operators were strongly advised to utilize the least volume possible of iodinated agents. This pilot survey included ten patients with symptomatic aortic stenosis and renal dysfunction who underwent zero-contrast multi-modality imaging.

Results: All the patients ultimately underwent TAVI. The intervention was successful in all cases, without ≥ moderate residual aortic regurgitation, prosthesis embolization, annulus rupture, major vascular complications, stroke, or death during index hospitalization. The creatinine clearance remained stable throughout the observation period (baseline: 26.85 ± 12.55 mL/min; after multi-modality imaging: 26.76 ± 11.51 mL/min; post-TAVI at discharge: 29.84 ± 13.98 mL/min; = 0.3 all).

Conclusion: The proposed contrast-free imaging protocol appears to be a promising clinical tool for pre-TAVI evaluation in patients with severe renal dysfunction.

Citing Articles

Pre-Procedural Assessment of the Femoral Access Route for Transcatheter Aortic Valve Implantation: Comparison of a Non-Contrast Time-of-Flight Magnetic Resonance Angiography Protocol with Contrast-Enhanced Dual-Source Computed Tomography Angiography.

Brado J, Breitbart P, Hein M, Pache G, Schmitt R, Hein J J Clin Med. 2023; 12(21).

PMID: 37959289 PMC: 10647847. DOI: 10.3390/jcm12216824.

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