30 days and midterm outcomes of patients undergoing percutaneous replacement of aortic valve according to their renal function: A multicenter study

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• 作者：Fabrizio D'Ascenzo ; Claudio Moretti ; Stefano Salizzoni ; Mario Bollati ; Maurizio D'Amico ; Flavia Ballocca ; Francesca Giordana ; Marco Barbanti ; Gian Paolo Ussia ; Nedy Brambilla ; Francesco Bedogni ; Giuseppe Biondi Zoccai ; Corrado Tamburino ; Fiorenzo Gaita ; Imad Sheiban
• 关键词：TAVI ; Renal function ; Bleedings ; Stroke ; Improvement in renal clearance
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：20 August, 2013
• 年：2013
• 卷：167
• 期：4
• 页码：1514-1518
• 全文大小：236 K

文摘

Introduction

Chronic kidney disease (CKD) constitutes a predictor of adverse events for surgical aortic valve replacement. In patients undergoing TAVI no study was performed to evaluate outcomes according to renal clearance, which represents the most accurate instrument to assess kidney function.

Methods

From January 2007 to December 2011 all TAVI patients of our institutions were prospectively divided into 3 cohorts. Preserved renal function those with clearance more or equal to 60 ml/min/1.73 m2, moderate CKD those between 30 and 60, and severe CKD those between 15 and 30. Patients with a clearance less than 15 or in dyalysis were excluded. All outcomes were adjudicated according to VARC criterion.

Results

72 patients with preserved renal function, 219 with moderate and 73 with severe CKD were included; those in the latter group were older and with lower ejection fraction. At 30 days, severe CKD was associated with a trend toward a higher risk of major events than preserved and moderate CKD: cardiovascular death (2.8 % vs 6.7 % vs 9 % ; p = 0.256) life threatening bleedings (10 % vs 10 % vs 16 % ; p = 0.384), major stroke (1.4 % vs 2.3 % vs 4.1 % ; p = 0.763). At a medium follow-up of 540 ¡À 250 days, cardiovascular death incidence was higher in patients with severe CKD (7 % vs 8 vs 19 % ; p < 0.0001), however this difference was not consistently significant after multivariable adjustment (p = 0.300). Overall, 2 % of patients developed kidney failure, whereas 47.1 % of patients with severe CKD improved to moderate renal impairment.

Conclusions

Patients with severe chronic renal disease presented higher risk of adverse events, mainly driven by increased hazard of bleedings. TAVI procedures could offer kidney functional improvement in an important subset of patients.