Impact of Preoperative Chronic Kidney Disease in 2,531 High-Risk and Inoperable Patients Undergoing Transcatheter Aortic Valve Replacement in the PARTNER Trial

Thourani, Vinod H.; Forcillo, Jessica; Beohar, Nirat; Doshi, Darshan; Parvataneni, Rupa; Ayele, Girma Minalu; Kirtane, Ajay J.; Babaliaros, Vasilis; Kodali, Susheel; Devireddy, Chandan; Szeto, Wilson Y.; Herrmann, Howard C.; Makkar, Raj; Ailawadi, Gorav; Lim, Scott; Maniar, Hersh S.; Zajarías, Alan; Suri, Rakesh M.; Tuzcu, E. Murat; Kapadia, Samir; Svensson, Lars G.; Condado, José F.; Jensen, Hanna; Mack, Michael J.; Leon, Martin B.

doi:10.1016/j.athoracsur.2016.07.001

Cited by 76 publications

(69 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, in pre-dialytic or dialytic CKD patients (S5), TAVI appears futile with very poor outcomes even when performed not necessarily in nonagenarians, although in severe CKD (S4) patients, a more rigorous selection is required to avoid such outcomes. Indeed, other studies have confirmed that preprocedural severe CKD is a significant predictor for 1-year mortality in TAVI patients (32). The accumulated evidence over the years shows that most cardiac surgical procedures can be performed in the elderly with very satisfactory outcomes.…”

Section: Comorbiditiesmentioning

confidence: 94%

“…This holds true for TAVI procedures as well (34). Among comorbidities, cerebrovascular disease, CKD and frailty appear to confer a worse outcome in the very elderly (23,(30)(31)(32). Careful patient selection, a lege artis procedure, a minimalistic approach and vascular hemostasis are of utmost importance for a successful TAVI procedure (35,36).…”

Section: Comorbiditiesmentioning

confidence: 99%

See 1 more Smart Citation

Transcatheter aortic valve implantation in nonagenarians: selectively feasible or extravagantly futile?

Manolis¹,

Manolis²

2017

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

A growing number of nonagenarians is recorded as life expectancy increases. Unfortunately, this extreme-aged group is plagued by increased prevalence of aortic stenosis amidst a higher occurrence of comorbidities that pose dilemmas to cardiologists and cardiac surgeons when having to choose a conservative or interventional treatment modality, and a surgical or transcatheter aortic valve implantation (TAVI) approach. TAVI is an expensive procedure, which also confers a higher mortality and morbidity risk in nonagenarians, compared to younger patients. Considering the physiologic rather the chronologic age alone, and adopting a shared-decision making approach (participatory medicine), it may be more realistic to determine a patient's candidacy for this non-surgical therapeutic modality. Thus, it comes down to the patient selection process by having the heart team review each nonagenarian case individually and getting the patient and the family involved, always aiming to prolong and improve patient's quality of life (QoL), but also taking into consideration patient preferences and values, sharing and respecting goals, realistic expectations, and end-of-life views and ideas. One should keep in mind that there is always the possibility that TAVI may be clinically futile for patients who have a multitude of comorbidities and extreme frailty, for whom a transition to palliative care might be prudent. Selecting nonagenarian patients with low comorbidity index and with no extreme frailty, adopting a minimalistic approach and paying attention to vascular access hemostasis may provide the elements that may lead to a successful, desirable and hopefully cost-effective outcome.

show abstract

Section: Comorbiditiesmentioning

confidence: 94%

Section: Comorbiditiesmentioning

confidence: 99%

Transcatheter aortic valve implantation in nonagenarians: selectively feasible or extravagantly futile?

Manolis¹,

Manolis²

2017

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

show abstract

“…As far as the prognostic effect of eGFR in AS is concerned, baseline renal failure potently predicted 6–18-month mortality in 262 patients undergoing BAV [31], 274 medically treated inoperable subjects (out of whom 65% underwent BAV) [32], as well as in large groups of patients after TAVI [33,34] or SVR [35]. Of note, post-discharge worsening of renal function, measured at 30 days after discharge, independently predicted one-year mortality in 168 post-TAVI patients [36].…”

Section: Discussionmentioning

confidence: 99%

Clinical Correlates and Prognostic Value of Plasma Galectin-3 Levels in Degenerative Aortic Stenosis: A Single-Center Prospective Study of Patients Referred for Invasive Treatment

Bobrowska

Wieczorek-Surdacka

Kruszelnicka

et al. 2017

IJMS

View full text Add to dashboard Cite

Galectin-3 (Gal-3), a β-galactoside-binding lectin, has been implicated in myocardial fibrosis, development of left ventricular (LV) dysfunction and transition from compensated LV hypertrophy to overt heart failure (HF), being a novel prognostic marker in HF. Risk stratification is crucial for the choice of the optimal therapy in degenerative aortic stenosis (AS), affecting elderly subjects with coexistent diseases. Our aim was to assess correlates and prognostic value of circulating Gal-3 in real-world patients with degenerative AS referred for invasive treatment. Gal-3 levels were measured at admission in 80 consecutive patients with symptomatic degenerative AS (mean age: 79 ± 8 years; aortic valve area (AVA) index: 0.4 ± 0.1 cm2/m2). The therapeutic strategy was chosen following a dedicated multidisciplinary team-oriented approach, including surgical valve replacement (n = 11), transcatheter valve implantation (n = 19), balloon aortic valvuloplasty (BAV) (n = 25) and optimal medical therapy (n = 25). Besides routine echocardiographic indices, valvulo-arterial impedance (Zva), an index of global LV afterload, was computed. There were 22 deaths over a median follow-up of 523 days. Baseline Gal-3 correlated negatively with estimated glomerular filtration rate (eGFR) (r = −0.61, p < 0.001) and was unrelated to age, symptomatic status, AVA index, LV ejection fraction, LV mass index or Zva. For the study group as a whole, Gal-3 tended to predict mortality (Gal-3 >17.8 vs. Gal-3 <17.8 ng/mL; hazard ratio (HR): 2.03 (95% confidence interval, 0.88–4.69), p = 0.09), which was abolished upon adjustment for eGFR (HR: 1.70 (0.61–4.73), p = 0.3). However, in post-BAV patients multivariate-adjusted pre-procedural Gal-3 was associated with worse survival (HR: 7.41 (1.52–36.1), p = 0.01) regardless of eGFR. In conclusion, the inverse eGFR–Gal-3 relationship underlies a weak association between Gal-3 and adverse outcome in patients with degenerative AS referred for invasive therapy irrespective of type of treatment employed. In contrast, pre-procedural Gal-3 appears an independent mortality predictor in high-risk AS patients undergoing BAV.

show abstract

“…As TAVR technology advances, efforts are under way to evolve TAVR from a procedure performed among high‐risk surgical turn‐downs to one done among lower‐risk patients, particularly those most likely to improve from it . COPD, particularly when associated with very low forced expiratory volume in 1 s values (<30% predicted), remains an important risk factor for poor outcomes following TAVR . It is now well established that patients with severe chronic lung disease have a significantly higher risk of both in‐hospital and 1‐year mortality following TAVR, and patients with moderate and severe COPD have fewer days alive and outside the hospital at 12 months following TAVR compared with others .…”

Section: What Are Other Unresolved Issues In This Patient Population?mentioning

confidence: 99%

Transcatheter or Surgical Aortic Valve Replacement in Patients With Chronic Lung Disease? The Answer, My Friend, Is Blowin’ in the Wind

Kumbhani

Kapadia

Jneid

2018

JAHA

View full text Add to dashboard Cite

Impact of Preoperative Chronic Kidney Disease in 2,531 High-Risk and Inoperable Patients Undergoing Transcatheter Aortic Valve Replacement in the PARTNER Trial

Abstract: Preoperative severe RD is a significant predictor for 1-year mortality in TAVR patients. Careful risk stratification by the heart team is required in patients with severe preprocedural RD.

Cited by 76 publications

References 17 publications

Transcatheter aortic valve implantation in nonagenarians: selectively feasible or extravagantly futile?

Transcatheter aortic valve implantation in nonagenarians: selectively feasible or extravagantly futile?

Clinical Correlates and Prognostic Value of Plasma Galectin-3 Levels in Degenerative Aortic Stenosis: A Single-Center Prospective Study of Patients Referred for Invasive Treatment

Transcatheter or Surgical Aortic Valve Replacement in Patients With Chronic Lung Disease? The Answer, My Friend, Is Blowin’ in the Wind

Contact Info

Product

Resources

About