scholarly journals 374 Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gabriele Venturi ◽  
Roberto Scarsini ◽  
Michele Pighi ◽  
Paolo Alberto Del Sole ◽  
Andrea Mainardi ◽  
...  
Keyword(s):  
Creatinine Clearance ◽  
Adverse Outcome ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Early Mortality ◽  
Clearance Ratio ◽  
Transcatheter Aortic Valve ◽  
One Year ◽  
The Individual ◽  
Valve Implantation

Abstract Aims 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. Methods and results A large retrospective multicentre cohort of 1381 patients treated with TAVI was analysed to assess the association between CV/CrCl and the risk of AKI and mortality at 90 days and one year after TAVI. Patients receiving renal replacement therapy at the time of TAVI were excluded. CV/CrCl 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 (HR: 1.16, 95% 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 (OR: 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. Conclusions 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.

Abstract 4510: Pulmonary Hypertension before Transcatheter Aortic Valve Implantation Is Reversible and Lacks Prognostic Significance

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Abdullah M Al Ali ◽  
Brad Munt ◽  
Lukas Altwegg ◽  
Karin Humphries ◽  
Ronald Carere ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pulmonary Artery ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Group Iii ◽  
Transcatheter Aortic Valve ◽  
Group I ◽  
Group Ii ◽  
One Year ◽  
Valve Implantation

The prognostic significance of pulmonary hypertension (PH) and the potential for reversibility in the setting of aortic stenosis (AS) have been debated. We examined the clinical correlates and prognostic significance of PH in high risk elderly patients with symptomatic severe AS undergoing transcatheter aortic valve implantation (AVI). AVI was performed in 143 patients. Adequate echocardiographic estimation of baseline pulmonary artery systolic pressure was available in 115 (80%). Patients were divided into 3 groups according to baseline pulmonary artery pressure estimated by transthoracic echocardiogram: I: <30 mmHg, II: 30 –50 mmHg and III: >50 mmHg. Clinical and echocardiographic follow-up was obtained at 1, 6 and 12 months after AVI. Group I consisted of 17 patients (15%), group II 58 patients (50%) and group III 40 patients (35%). At baseline the three groups were similar in terms of age, functional status, presence of severe pulmonary disease, aortic valve area and mean gradient. Patients with severe PH (group III) were more likely to have left ventricular dysfunction (LVEF <50%) than patients with mild to moderate PH (groups I and II) (52% vs. 21%, p=0.002) and had more severe mitral regurgitation (grade ≥ 3 in 68% vs. 41%, p =0.0002). At one month, systolic pulmonary artery pressure fell significantly in group III (11.0 ± 14.3 mmHg, p=0.0008) and this reduction was maintained at 6 months. However, the changes in group I (increase of 7.1 ± 8.7 mmHg, p=0.07) and group II (decrease of 0.9 ± 9.3 mmHg, p=0.53) were not significant. Mortality at one year following AVI was 21%, but was not related to severity of PH. Using group III as a reference, hazard ratios were 0.83 (95% CI: 0.24 –2.9) for group I and 0.88 (95% CI: 0.4 –1.9) for group II. In elderly patients with severe AS treated with transcatheter AVI, severe PH is associated with more depressed left ventricular function and more severe mitral regurgitation. Severe PH is associated with a significant and greater fall in pulmonary pressure following AVI and does not influence one year survival.

scholarly journals P0709RENAL OUTCOMES AND MORTALITY FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION IN CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Amir Shabaka ◽  
Rafael Lucena Valverde ◽  
Andres Escudero ◽  
Gabriela Tirado-Conte ◽  
Luis Nombela Franco
Keyword(s):  
Kidney Disease ◽  
Serum Creatinine ◽  
Kidney Function ◽  
Severe Aortic Stenosis ◽  
Kidney Injury ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation

Abstract Background and Aims Transcatheter aortic valve implantation (TAVI) is indicated for the treatment of patients with severe aortic stenosis with a high surgical risk that are rejected for surgical valve placement. The aim of this study is to evaluate the effect of TAVI on long-term kidney function in stage 3-4 chronic kidney disease (CKD) patients. Method We performed a single-center retrospective observational study of 529 consecutive patients that underwent TAVI between August 2007 and January 2018. We included patients with stage 3 or 4 CKD, with at least two stable measurements of glomerular filtration rate during the three months before TAVI. We excluded patients that presented with an acute kidney injury during the three months that preceded TAVI. Results 165 patients (31.3%) of the patients who underwent TAVI had a stable stage 3 or 4 CKD before implantation. Their mean age was 83.61 ±5.08 years, BMI of 27.79 ± 4.54 kg/m2, baseline serum creatinine of 1.62 ± 0.49 mg/dl for an eGFR measured by MDRD-4 of 40.19 ± 10.79 ml/min, EuroScore-II of 6 (IQR 4-8). 42 patients (28.6%) had a post-procedural acute kidney injury (AKI), 2 of them required temporary renal replacement therapy and 30 patients (71.4%) recovered to their baseline kidney function. Mean contrast media administered was 162.0 ±77.8 ml. Mean serum creatinine decreased from 1.64 ± 0.51 mg/dl to 1.46 ± 0.52 ml/min after 1 year of follow-up (p=0.032). Only 2.4% of patients showed a &gt;50% increase in serum creatinine after 1 year. Median follow-up was 3.8 years (IQR 2.3-5.7 years) during which time no patient progressed to end-stage kidney disease. 33.3 % of patients died during follow-up, with a one-year survival rate of 87% and two-year survival of 82%. Post-interventional major bleeding (14.6 vs 5.8%, p&lt;0.001) and the need for post-interventional pacemaker implantation (25 vs 13.3%, p&lt;0,001)were the only risk factors associated with the development of AKI. Contrast volume was not associated with the development of AKI. AKI was associated with an increased in-hospital stay (13.2 vs 7.4 days, p&lt;0.001), but was not associated with either a reduced kidney function at end of follow-up or an increased mortality (Log-rank X2=1.72, p=0,578). Conclusion Despite the high incidence of post-interventional AKI after TAVI, our study did not show an association between AKI and increased mortality or reduced renal survival. In most cases after AKI patients recovered to their baseline kidney function. There is an improvement in kidney function after one year of treatment of severe aortic stenosis with TAVI in patients with CKD Stage 3-4.

scholarly journals Az első 200 transzkatéteres aortabillentyű-implantáció a Gottsegen György Országos Kardiológiai Intézetben

2016 ◽  
Vol 157 (45) ◽  
pp. 1786-1792
Author(s):  
Géza Fontos ◽  
Gábor Dékány ◽  
Nikolett Hegedüs ◽  
Zsolt Piróth ◽  
Chaurasia Amit Kumar ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Daily Routine ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation

Introduction: Transcatheter aortic valve implantation is a therapeutic alternative for contraindicated and high surgical risk patients with severe symptomatic aortic stenosis. This intervention is part of daily routine in the Institute of the authors. Aim: In the present work the results of the first 200 patients are discussed. Method: Until January, 2016, 200 patients (female 55%, mean age 79.9 years, average EuroSCORE 19.3%, left ventricular ejection fraction 54%, peak gradient 81.2 mmHg, mean aortic gradient 50.9 mmHg) underwent transcatheter aortic valve implantation. Results: The procedure was performed with 99% success rate. Complications were evaluated according to VARC 2 definitions. Mortality was 5% at one month and 17.4% at one year. Cardiac mortality was 13.6 at one year. Cerebrovascular complications were 5% within one year, and 95% of patients were in NYHA I or II functional classes at one year. Conclusion: These findings are consistent with worldwide results. Orv. Hetil., 2016, 157(45), 1786–1792.

Left Ventricular Mass Regression One Year After Transcatheter Aortic Valve Implantation

2011 ◽  
Vol 91 (3) ◽  
pp. 685-691 ◽  
Author(s):  
Apostolos Tzikas ◽  
Marcel L. Geleijnse ◽  
Nicolas M. Van Mieghem ◽  
Carl J. Schultz ◽  
Rutger-Jan Nuis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricular Mass ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Ventricular Mass ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation
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