Association of Transcatheter Aortic Valve Replacement With 30-Day Renal Function and 1-Year Outcomes Among Patients Presenting With Compromised Baseline Renal Function

Beohar, Nirat; Doshi, Darshan; Thourani, Vinod H.; Jensen, Hanna; Kodali, Susheel; Zhang, Feifan; Zhang, Yiran; Davidson, Charles J.; McCarthy, Patrick M.; Mack, Michael J.; Kapadia, Samir; Leon, Martin B.; Kirtane, Ajay J.

doi:10.1001/jamacardio.2017.1220

Cited by 45 publications

(74 citation statements)

References 31 publications

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“…In patients with moderate/severe CKD, we found baseline clinical features associated with increased disease burden and frailty to be predictors of 1‐year all‐cause mortality, consistent with previous studies,,. Also consistent with others, we found multi‐valvular involvement including tricuspid regurgitation to be associated with 1‐year all‐cause mortality, thus, the presence of such multi‐valvular pathology should be carefully considered in counseling patients.…”

Section: Discussionsupporting

confidence: 90%

“…Consistent with others, we found a high frequency of moderate/severe CKD among the high‐ to extreme‐risk patients undergoing TAVR and high‐risk patients randomized to SAVR, which is likely to be multifactorial. While previous studies provided short‐term outcomes, the UK TAVI registry and the present study provide mid‐term (3‐year) outcomes.…”

Section: Discussionsupporting

confidence: 88%

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Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Pineda

Harrison

Kleiman

et al. 2018

Cathet Cardio Intervent

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Objectives To assess the treatment effect of TAVR versus SAVR on clinical outcomes to 3 years in patients stratified by chronic kidney disease (CKD) by retrospectively studying patients randomized to TAVR or SAVR. Background The impact of CKD on mid‐term outcomes of patients undergoing TAVR versus SAVR is unclear. Methods Patients randomized to TAVR or SAVR in the CoreValve US Pivotal High Risk Trial were retrospectively stratified by eGFR: none/mild or moderate/severe CKD. To evaluate the impact of baseline CKD in TAVR patients only, all patients undergoing an attempted TAVR implant in the US Pivotal Trial and CAS were stratified by baseline eGFR into none/mild, moderate, and severe CKD. The primary endpoint was major adverse cardiovascular and renal events (MACRE), a composite of all‐cause mortality, myocardial infarction, stroke/TIA, and new requirement of dialysis. Results Moderate/severe CKD was present in 62.7% and 60.7% of high‐risk patients randomized to TAVR or SAVR, respectively. Baseline characteristics were similar between TAVR and SAVR patients in both CKD subgroups, except for higher rates of diabetes and higher serum creatinine in SAVR patients. Among high‐risk patients with moderate/severe CKD, TAVR provided a lower 3‐year MACRE rate compared with SAVR: 42.1% vs. 51.0, P = .04. Of 3,733 extreme‐ and high‐risk TAVR patients, 39.9% had none/mild, 53.8% moderate, and 6.4% severe CKD. Worsening baseline CKD was associated with increased 3‐year MACRE rates [none/mild 51.5%, moderate 54.5%, severe 63.1%, P = .001]. Conclusions TAVR results in lower 3‐year MACRE versus SAVR in high‐risk patients with moderate/severe CKD. In patients undergoing TAVR, worsening CKD increases mid‐term mortality and MACRE. Randomized trials of TAVR vs. SAVR in patients with moderate‐severe CKD would help elucidate the best treatment for these complex patients. Trial Registration CoreValve US Pivotal Trial: NCT01240902. CoreValve Continued Access Study: NCT01531374.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Pineda

Harrison

Kleiman

et al. 2018

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

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“…Further, continued smoking and decreased left ventricular ejection fraction were associated with worsening GFR in a recent study conducted by Beohar et al…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 86%

“…Further, a recent substudy from the PARTNER 1 registry showed that in patients with baseline renal impairment, those with worsening GFR had an increased all‐cause mortality at 1 year. However, it is also interesting to note that 76% of the patients did not have their baseline renal impairment exacerbated following TAVR . Conflicting reports exist with regard to sex‐based risk, with some studies showing higher risk in males whereas others find females to be at greater risk of AKI .…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

Acute kidney injury post–transcatheter aortic valve replacement

Ram

Mezue

Pressman

et al. 2017

Clinical Cardiology

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Transcatheter aortic valve replacement (TAVR) is a treatment option in high-risk patients with severe aortic stenosis who are not surgical candidates. In light of emerging evidence, it is being increasingly performed even in intermediate-risk patients in recent years. Patients who develop acute kidney injury (AKI) following TAVR are known to have worse outcomes. The objective of this concise review was to identify the prevalence and the impact of AKI following TAVR on patient outcomes by including the most recent literature in our search. After a thorough search on MEDLINE, Google Scholar, and PubMed, we included all literature relevant to AKI following TAVR. We found that AKI was caused by a variety of reasons, such as hemodynamic instability during rapid pacing, blood transfusion, periprocedural embolization, and use of contrast medium, to name a few. In patients who developed AKI following TAVR, 30-day and 1-year mortality were increased. Further, in these patients, length and cost of hospital stay were increased as well. Preventive measures such as optimal periprocedural hydration, careful contrast use, and techniques to prevent embolization during device implantation have been tried with limited success. Given that TAVR is expected to be increasingly performed, this review aimed to summarize the rapidly expanding currently available literature in an effort to reduce procedural complications and thereby improve patient outcomes.

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“…This stems from the fact that contrast used in MDCT in pre‐TAVR aortic annulus sizing can induce kidney injury in as many as 7% to 10.5% of patients and the risk of this complication is much higher if the patient has pre‐existing renal impairment . Renal impairment in pre‐TAVR setting has been demonstrated as a pivotal predictor of morbidity and mortality …”

Section: Introductionmentioning

confidence: 99%

Three‐dimensional transesophageal echocardiography is an attractive alternative to cardiac multi‐detector computed tomography for aortic annular sizing: Systematic review and meta‐analysis

et al. 2018

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Background Cardiac imaging is the cornerstone of the pretranscatheter aortic valve replacement (TAVR) assessment. Multi‐detector computed tomography (MDCT) is considered the conventional imaging modality. However, there is still no definitive gold standard. Targeted cohort of inoperable high‐risk patients with underlying comorbidities, particularly renal impairment, makes apparent the need for MDCT alternative. We aimed to demonstrate the correlation extent between MDCT and three‐dimensional transesophageal echocardiography (3DTEE) aortic annular area measures and to answer the question: Is 3DTEE a good alternative to MDCT? Methods A systematic literature search and meta‐analysis were conducted to evaluate the degree of correlation and agreement between 3DTEE and MDCT aortic annular sizing. A thorough assessment of EMBASE, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed. All studies comparing 3DTEE and MDCT in relation to aortic annular sizing were included. Results Thirteen studies were included (N = 1228 patients). A strong linear correlation was found between 3DTEE and MDCT measurements of aortic annulus area (r = 0.84, P < 0.001), mean perimeter (r = 0. 0.85, P < 0.001), and mean diameter (r = 0.80, P < 0.001). Bland–Altman plots revealed smaller mean 3DTEE values in comparison to MDCT for aortic annular area, the mean difference being −2.22 mm2 with 95% limits of agreement −12.79 to 8.36. Conclusion Aortic annulus measurements obtained by 3DTEE demonstrated a high level of correlation with those evaluated by MDCT. This makes 3DTEE a feasible choice for aortic annulus assessment, with advantage of real time assessment, lack of contrast, and no radiation exposure.

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Association of Transcatheter Aortic Valve Replacement With 30-Day Renal Function and 1-Year Outcomes Among Patients Presenting With Compromised Baseline Renal Function

Abstract: clinicaltrials.gov Identifier: NCT00530894.

Cited by 45 publications

References 31 publications

Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Acute kidney injury post–transcatheter aortic valve replacement

Three‐dimensional transesophageal echocardiography is an attractive alternative to cardiac multi‐detector computed tomography for aortic annular sizing: Systematic review and meta‐analysis

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