Accuracy of Ferumoxytol-Enhanced MRA-Guided TAVR in Patients With Chronic Kidney Disease

Melo, Diana; Agrawal, Harsh; Parikh, Devang S; Sarwary, Shabir; Lin, Shing-Jong; Choy, Ho-Hin; Mallawaarachchi, Indika; Kallianos, Kimberley; Hope, Michael D.; Mahadevan, Vaikom S.

doi:10.1016/j.jcin.2021.12.008

“…Using respiratory and electrocardiographic gating, FE-MRA can evaluate the ascending aorta within 10 minutes, yielding reproducible measurements of the aortic annulus area [ 45 ]. In the largest studies to date, involving 31 patients, TAVR guided by FE-MRA demonstrated a 96% success rate, with no complications observed in any patient within a month after the TAVR [ 46 ]. In TAVR procedures of accessing iliofemoral arteries, the intimal diameter and curvature extent are both crucial for predicting the feasibility [ 7 ].…”

Section: Clinical Applications During the Blood Pool Phasementioning

confidence: 99%

Unveiling the next generation of MRI contrast agents: current insights and perspectives on ferumoxytol-enhanced MRI

Si,

Du,

Tang

et al. 2024

National Science Review

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Contrast-enhanced magnetic resonance imaging (CE-MRI) is a pivotal tool for global disease diagnosis and management. Since its clinical availability in 2009, the off-label use of ferumoxytol for ferumoxytol-enhanced MRI (FE-MRI) has significantly reshaped CE-MRI practices. Unlike MRI that's enhanced by gadolinium-based contrast agents, FE-MRI offers advantages such as reduced contrast agent dosage, extended imaging windows, no nephrotoxicity, higher MRI time efficiency, and the capability for molecular imaging. As a leading superparamagnetic iron oxide contrast agent, ferumoxytol is heralded as the next generation of contrast agents. This review delineates the pivotal clinical applications and inherent technical superiority of FE-MRI, providing an avant-garde medical-engineering interdisciplinary lens, thus bridging the gap between clinical demands and engineering innovations. Concurrently, we spotlight the emerging imaging themes and new technical breakthroughs. Lastly, we share our own insights on the potential trajectory of FE-MRI, shedding light on its future within the medical imaging realm.

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“…Factors that can contribute to AKI are nephrotoxicity of contrast medium, blood transfusions, renal hypoperfusion during rapid ventricular pacing, and microembolization of cholesterol plaque into the renal vasculature with vascular instrumentation [ 25 , 37 ]. Risk stratification of patients based on eGFR could help prevent this complication by focusing on pre-procedural volume optimization and limitation of contrast load, with emerging evidence of alternate imaging modalities to limit or avoid iodinated contrast [ 39 – 42 ]. To date, the optimal choice of anesthetic strategy for renal protection during TAVR remains unclear.…”

Section: Discussionmentioning

confidence: 99%

In-hospital outcomes of transcatheter aortic valve replacement in patients with chronic and end-stage renal disease: a nationwide database study

Lorente-Ros,

Das,

Malik

et al. 2024

BMC Cardiovasc Disord

1

0

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Background Chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been associated with worse outcomes after transcatheter aortic valve replacement (TAVR). With TAVR indications extending to a wider range of patient populations, it is important to understand the current implications of chronic renal insufficiency on clinical outcomes. We aim to determine the impact of CKD and ESRD on in-hospital outcomes after TAVR. Methods We queried the National Inpatient Sample for TAVR performed between 2016 and 2020 using International Classification of Diseases-10th Revision codes. We compared in-hospital mortality and clinical outcomes between three groups: normal renal function, CKD and ESRD. The association between CKD/ESRD and outcomes was tested with multivariable logistic regression analyses, using normal renal function as baseline. Results In the five-year study period, 279,195 patients underwent TAVR (mean age 78.9 ± 8.5 years, 44.4% female). Of all patients, 67.1% had normal renal function, 29.2% had CKD, and 3.7% had ESRD. There were significant differences in age, sex, and prevalence of comorbidities across groups. In-hospital mortality was 1.3%. Compared to patients with normal renal function, patients with renal insufficiency had higher in-hospital mortality, with the highest risk found in patients with ESRD (adjusted odds ratio: 1.4 [95% confidence interval: 1.2–1.7] for CKD; adjusted odds ratio: 2.4 [95% confidence interval: 1.8–3.3] for ESRD). Patients with CKD or ESRD had a higher risk of cardiogenic shock, need for mechanical circulatory support, and vascular access complications, compared to those with normal renal function. In addition, patients with ESRD had a higher risk of cardiac arrest and periprocedural acute myocardial infarction. The incidence of conversion to open heart surgery was 0.3% and did not differ between groups. Post-procedural infectious and respiratory complications were more common among patients with CKD or ESRD. Conclusion Patients with CKD and ESRD are at higher risk of in-hospital mortality, cardiovascular, and non-cardiovascular complications after TAVR. The risk of complications is highest in patients with ESRD and does not result in more frequent conversion to open heart surgery. These results emphasize the importance of individualized patient selection for TAVR and procedural planning among patients with chronic renal insufficiency.

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“…Factors that can contribute to AKI are nephrotoxicity of contrast medium, blood transfusions, renal hypoperfusion during rapid ventricular pacing, and microembolization of cholesterol plaque into the renal vasculature with vascular instrumentation [25,37]. Risk strati cation of patients based on eGFR could help prevent this complication by focusing on pre-procedural volume optimization and limitation of contrast load, with emerging evidence of alternate imaging modalities to limit or avoid iodinated contrast [39][40][41][42]. To date, the optimal choice of anesthetic strategy for renal protection during TAVR remains unclear.…”

Section: Discussionmentioning

confidence: 99%

In-Hospital Outcomes of Transcatheter Aortic Valve Replacement in Patients with Chronic and End-Stage Renal Disease: A Nationwide Database Study

Lorente-Ros

¹

,

Das

²

,

Malik

³

et al. 2023

Preprint

0

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Background Chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been associated with worse outcomes after transcatheter aortic valve replacement (TAVR). With TAVR indications extending to a wider range of patient populations, it is important to understand the current implications of chronic renal insufficiency on clinical outcomes. We aim to determine the impact of CKD and ESRD on in-hospital outcomes after TAVR. Methods We queried the National Inpatient Sample for TAVR performed between 2016 and 2020 using International Classification of Diseases-10th Revision codes. We compared in-hospital mortality and clinical outcomes between three groups: normal renal function, CKD and ESRD. The association between CKD/ESRD and outcomes was tested with multivariable logistic regression analyses, using normal renal function as baseline. Results In the five-year study period, 279,195 patients underwent TAVR (mean age 78.9 ± 8.5 years, 44.4% female). Of all patients, 67.1% had normal renal function, 29.2% had CKD, and 3.7% had ESRD. There were significant differences in age, sex, and prevalence of comorbidities across groups. In-hospital mortality was 1.3%. Compared to patients with normal renal function, patients with renal insufficiency had higher in-hospital mortality, with the highest risk found in patients with ESRD (adjusted odds ratio: 1.4 [95% confidence interval: 1.2–1.7] for CKD; adjusted odds ratio: 2.4 [95% confidence interval: 1.8–3.3] for ESRD). Patients with CKD or ESRD had a higher risk of cardiogenic shock, need for mechanical circulatory support, and vascular access complications, compared to those with normal renal function. In addition, patients with ESRD had a higher risk of cardiac arrest and periprocedural acute myocardial infarction. The incidence of conversion to open heart surgery was 0.3% and did not differ between groups. Post-procedural infectious and respiratory complications were more common among patients with CKD or ESRD. Conclusion Patients with CKD and ESRD are at higher risk of in-hospital mortality, cardiovascular, and non-cardiovascular complications after TAVR. The risk of complications is highest in patients with ESRD and does not result in more frequent conversion to open heart surgery. These results emphasize the importance of individualized patient selection for TAVR and procedural planning among patients with chronic renal insufficiency.

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Accuracy of Ferumoxytol-Enhanced MRA-Guided TAVR in Patients With Chronic Kidney Disease

Cited by 3 publications

References 5 publications

Unveiling the next generation of MRI contrast agents: current insights and perspectives on ferumoxytol-enhanced MRI

Unveiling the next generation of MRI contrast agents: current insights and perspectives on ferumoxytol-enhanced MRI

In-hospital outcomes of transcatheter aortic valve replacement in patients with chronic and end-stage renal disease: a nationwide database study

In-Hospital Outcomes of Transcatheter Aortic Valve Replacement in Patients with Chronic and End-Stage Renal Disease: A Nationwide Database Study

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