Extravalvular Cardiac Damage and Renal Function Following Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

Pighi, Michele; Fezzi, Simone; Pesarini, Gabriele; Venturi, Gabriele; Giovannini, Davide; Castaldi, Gianluca; Lunardi, Mattia; Ferrero, Valeria; Scarsini, Roberto; Ribichini, Flavio

doi:10.1016/j.cjca.2020.12.021

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…The toxic effect of contrast media is an important component of the AKI pathogenesis 21 . Other patient‐related AKI predictors including baseline CKD, 22 DM, 23 peripheral arterial disease, 23 impaired left ventricular function, 2,24 and extra‐valvular cardiac damage may stratify the baseline risk of patients undergoing TAVI 25 . Moreover, periprocedural variables may contribute to the risk of AKI, including embolization to the renal vasculature 26 and renal hypoperfusion related to vascular complications, bleeding or rapid pacing.…”

Section: Discussionmentioning

confidence: 99%

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Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI

Venturi

Scarsini

Pighi

et al. 2022

Cathet Cardio Intervent

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The volume of contrast to creatinine clearance ratio (CV/CrCl) is a useful indicator of the risk of acute kidney injury (AKI) in patients undergoing percutaneous interventional procedures. Association between CV/CrCl and adverse outcome after transcatheter aortic valve implantation (TAVI) was suggested but it is not well established. A large retrospective multicenter cohort of 1381 patients treated with TAVI was analyzed to assess the association between CV/CrCl and the risk of AKI and mortality at 90 days and 1 year after TAVI. Patients receiving renal replacement therapy at the time of TAVI were excluded. CV/CrCl ≥ 2.2 was associated with the risk of AKI and 90 days mortality after TAVI after adjustment for age, sex, diabetes, baseline left ventricular function, baseline chronic kidney disease (CKD), previous myocardial infarction and peripheral vascular disease (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.09–1.22, p < 0.0001). Importantly, CV/CrCl was associated with the adverse outcome independently from the presence of baseline CKD (p for interaction = 0.22). CV/CrCl was independently associated with the individual components of the composite primary outcome including AKI (odds ratio: 1.18, 95% CI: 1.08–1.28, p < 0.0001) and 90 days mortality (HR: 1.90, 95% CI: 1.01–3.60, p = 0.047) after TAVI. AKI (HR: 1.94, 95% CI: 1.21–3.11, p = 0.006) but not CV/CrCl was associated with the risk of 1‐year mortality after TAVI. CV/CrCl is associated with excess renal damage and early mortality after TAVI. Procedural strategies to minimize the CV/CrCl during TAVI may improve early clinical outcomes in patients undergoing TAVI.

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Section: Discussionmentioning

confidence: 99%

“…1929 ventricular function,2,24 and extra-valvular cardiac damage may stratify the baseline risk of patients undergoing TAVI 25. Moreover, periprocedural variables may contribute to the risk of AKI, including embolization to the renal vasculature26 and renal hypoperfusion related to vascular complications, bleeding or rapid pacing.…”

mentioning

confidence: 99%

Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI

Venturi

Scarsini

Pighi

et al. 2022

Cathet Cardio Intervent

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“…Aortic stenosis may contribute to cardiorenal syndrome that improves with TAVR, but our observation suggests that reversible post TAVR cardiorenal syndrome patients still have increased mortality. The role of extra-valvular cardiac damage staging in aortic valve stenosis management is becoming a topic of interest [ 17 ]. Future research may determine the benefit of early TAVR in asymptomatic patients with cardiorenal syndrome [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury and acute kidney recovery following Transcatheter Aortic Valve Replacement

et al. 2021

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Background Acute kidney injury (AKI) is associated with a dismal prognosis in Transcatheter Aortic Valve replacement (TAVR). Acute kidney recovery (AKR), a phenomenon reverse to AKI has recently been associated with better outcomes. Methods Between November 2012 to May 2018, we explored consecutive patients referred to our Heart Valve Center for TAVR. AKI was defined according to the VARC-2 definition. Mirroring the VARC-2 definition of AKI, AKR was defined as a decrease in serum creatinine (≥50%) or ≥25% improvement in GFR up to 72 hours after TAVR. Results AKI and AKR were respectively observed in 8.3 and 15.7% of the 574 patients included. AKI and AKR patients were associated to more advanced kidney disease at baseline. At a median follow-up of 608 days (range 355–893), AKI and AKR patients experienced an increased cardiovascular mortality compared to unchanged renal function patients (14.6% and 17.8% respectively, vs. 8.1%, CI 95%, p<0.022). Chronic kidney disease, (HR: 3.9; 95% CI 1.7–9.2; p < 0.001) was the strongest independent factor associated with AKI similarly to baseline creatinine level (HR: 1; 95% CI 1 to 1.1 p < 0.001) for AKR. 72-hours post procedural AKR (HR: 2.26; 95% CI 1.14 to 4.88; p = 0.021) was the strongest independent predictor of CV mortality. Conclusions Both AKR and AKI negatively impact long term clinical outcomes of patients undergoing TAVR.

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Acute Kidney Recovery Following Transcatheter Aortic Valve Implantation: A Matter of Definition?

Fezzi¹,

Pighi

Ribichini³

2022

The American Journal of Cardiology

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Extravalvular Cardiac Damage and Renal Function Following Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

Cited by 7 publications

References 27 publications

Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI

Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI

Acute kidney injury and acute kidney recovery following Transcatheter Aortic Valve Replacement

Acute Kidney Recovery Following Transcatheter Aortic Valve Implantation: A Matter of Definition?

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