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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

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Improvement of renal function after transcatheter aortic valve replacement in patients with chronic kidney disease

Michel V Lemes da Silva1,2, Antonio C B Nunes Filho1, Vitor E E Rosa1,2

  • 1Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil.

Plos One
|May 13, 2021
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) can improve renal function in patients with aortic stenosis, but this improvement does not significantly impact long-term survival. Acute kidney injury following TAVR, however, is linked to increased mortality.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Chronic kidney disease (CKD) is prevalent in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
  • TAVR may improve renal function by reducing the hemodynamic burden of AS.
  • Predictors and consequences of renal function improvement post-TAVR require further elucidation.

Purpose of the Study:

  • To identify predictors of renal function improvement after TAVR in patients with baseline renal dysfunction.
  • To assess the clinical outcomes associated with TAVR-induced renal function improvement (TIRFI).

Main Methods:

  • Analysis of the Brazilian Registry of TAVR, a prospective non-randomized study.
  • Stratification of patients with baseline eGFR < 60mL/min/1.73m2 into TIRFI (>10% eGFR increase), AKI (>10% eGFR decrease), or stable renal function groups.
  • Identification of independent predictors for TIRFI using multivariable analysis.

Main Results:

  • In 819 patients, 70% had baseline renal dysfunction; 34.1% experienced TIRFI, 35.2% AKI, and 30.7% stable function.
  • Independent predictors of TIRFI included absence of coronary artery disease and lower baseline eGFR.
  • No significant difference in 30-day or 1-year mortality between TIRFI and stable renal function groups.
  • AKI post-TAVR was associated with significantly higher mortality (29.3%) compared to TIRFI (15.4%) and stable groups (9.5%).

Conclusions:

  • TIRFI is common in patients with pre-existing renal impairment undergoing TAVR.
  • TIRFI was not associated with improved 1-year all-cause mortality.
  • Acute kidney injury post-TAVR is a significant predictor of increased mortality.
Abstract

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