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The impact of transcatheter aortic valve implantation planning and procedure on acute and chronic renal failure
, 1, 3, 12, 45, 126, 4, 12, 126, 126
Affiliations- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Department of Nephrology, University Hospital Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center - Faculty of Medicine, University of Freiburg, Germany
- Division of Cardiac, Vascular and Thoracic Imaging, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Germany
- Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
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Abstract
Background: Severe aortic valve stenosis inhibits renal perfusion, thereby potentially worsening renal function, in particular in elderly patients most often assigned to transcatheter aortic valve implantation (TAVI). Pre-TAVI diagnostics and the procedure itself may adversely impact renal function, however renal perfusion and function may also improve post-procedure. This study aimed to clarify the impact of TAVI planning and procedure on kidney function Methods: In this retrospective study, kidney function of patients who underwent transfemoral TAVI at a tertiary university hospital between 2016 and 2019 was analyzed. The present study investigated kidney function at baseline, after computed tomography (CT) was performed for evaluation of TAVI, after TAVI, at discharge and at follow-up. Results: Among 366 patients, the prevalence of acute kidney injury (AKI) was 14.5% after TAVI. Independent predictors of AKI were arterial hypertension, baseline creatinine, AKI post CT and coronary intervention during pre-procedural diagnostics. At discharge and follow-up, 2.1% and 3.4%, respectively had sustained relevant impairment of kidney function (defined as creatinine/baseline creatinine > 1.5 or renal replacement therapy). Patients with known chronic kidney disease showed no higher rates of short- and long-term impairment, but higher rates of improvement of renal function after TAVI. Conclusions: In most cases TAVI does not worsen renal function. A sustained impairment after TAVI was found in only a few cases. This was independent of reduced baseline kidney function. Transfemoral TAVI can thus be planned and performed even in patients with higher stages of chronic kidney disease.
Abstract
Background: Severe aortic valve stenosis inhibits renal perfusion, thereby potentially worsening renal function, in particular in elderly patients most often assigned to transcatheter aortic valve implantation (TAVI). Pre-TAVI diagnostics and the procedure itself may adversely impact renal function, however renal perfusion and function may also improve post-procedure. This study aimed to clarify the impact of TAVI planning and procedure on kidney function Methods: In this retrospective study, kidney function of patients who underwent transfemoral TAVI at a tertiary university hospital between 2016 and 2019 was analyzed. The present study investigated kidney function at baseline, after computed tomography (CT) was performed for evaluation of TAVI, after TAVI, at discharge and at follow-up. Results: Among 366 patients, the prevalence of acute kidney injury (AKI) was 14.5% after TAVI. Independent predictors of AKI were arterial hypertension, baseline creatinine, AKI post CT and coronary intervention during pre-procedural diagnostics. At discharge and follow-up, 2.1% and 3.4%, respectively had sustained relevant impairment of kidney function (defined as creatinine/baseline creatinine > 1.5 or renal replacement therapy). Patients with known chronic kidney disease showed no higher rates of short- and long-term impairment, but higher rates of improvement of renal function after TAVI. Conclusions: In most cases TAVI does not worsen renal function. A sustained impairment after TAVI was found in only a few cases. This was independent of reduced baseline kidney function. Transfemoral TAVI can thus be planned and performed even in patients with higher stages of chronic kidney disease.
Keywords
kidney function, transcatheter aortic valve implantation, computed tomography, acute kidney failure
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About this articleTitle
The impact of transcatheter aortic valve implantation planning and procedure on acute and chronic renal failure
Journal
Issue
Article type
Original Article
Pages
247-255
Published online
2021-06-09
Page views
3141
Article views/downloads
609
DOI
10.5603/CJ.a2021.0057
Pubmed
Bibliographic record
Cardiol J 2023;30(2):247-255.
Keywords
kidney function
transcatheter aortic valve implantation
computed tomography
acute kidney failure
Authors
Markus Jäckel
Simon Keller
Eric Peter Prager
Dawid Leander Staudacher
Christopher Schlett
Manfred Zehender
Fabian Bamberg
Christoph Bode
Constantin von Zur Mühlen
Peter Stachon
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