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The impact of transcatheter aortic valve implantation planning and procedure on acute and chronic renal failure

Markus Jäckel, Simon Keller, Eric Peter Prager, Dawid Leander Staudacher, Christopher Schlett, Manfred Zehender, Fabian Bamberg, Christoph Bode, Constantin von zur Mühlen, Peter Stachon
DOI: 10.5603/CJ.a2021.0057

open access

Ahead of print
Original articles
Published online: 2021-06-09

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.

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Keywords

kidney function, transcatheter aortic valve implantation, computed tomography, acute kidney failure

Supp./Additional Files (3)
Supplemental Table 1 and Table 2
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Supplemental Figure 1. Flowchart indicating number of included and excluded patients. Data are given as number of patients
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Supplemental Figure 2 Multivariate analysis of risk factors for AKI after computed tomography. Predictors of AKI after computed tomography. Figure shows multivariate logistic regression analysis with odds ratio (95% confidence interval) of different predi
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About this article
Title

The impact of transcatheter aortic valve implantation planning and procedure on acute and chronic renal failure

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-06-09

DOI

10.5603/CJ.a2021.0057

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

References (21)
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