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Impact on Kidney Function and Medium-Term Outcomes of Transcatheter Aortic Valve Replacement in Patients With Chronic

Jwan A Naser1, Sushil Allen Luis1, Sorin V Pislaru1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.

The American Journal of Cardiology
|October 20, 2023
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) outcomes in patients with chronic kidney disease (CKD) show that advanced CKD stages predict mortality beyond two years. Kidney function often improves post-TAVR.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Transcatheter aortic valve replacement (TAVR) is a standard treatment for aortic stenosis.
  • Long-term TAVR outcomes and their predictors in patients with chronic kidney disease (CKD) remain unclear.
  • Understanding these outcomes is crucial for optimizing patient care.

Purpose of the Study:

  • To assess medium-term TAVR outcomes in patients with varying stages of CKD.
  • To develop a risk score for predicting 2-year mortality in CKD patients undergoing TAVR.
  • To evaluate changes in kidney function following TAVR.

Main Methods:

  • Retrospective analysis of adult patients who underwent TAVR.
  • CKD staging determined using the CKD Epidemiology 2021 creatinine formula.
  • Kidney function improvement defined by specific creatinine level changes post-TAVR.

Main Results:

  • Higher all-cause mortality observed in CKD stages IV and V at a median follow-up of 2.9 years.
  • Independent predictors of 2-year mortality included moderate/severe tricuspid regurgitation, anemia, elevated right ventricular systolic pressure, and advanced CKD stages (IV/V).
  • At discharge, 6% experienced persistent acute kidney injury, while 12% showed improved kidney function.

Conclusions:

  • CKD stage is an independent determinant of mortality beyond two years post-TAVR.
  • A novel risk score can estimate 2-year mortality in TAVR patients with CKD.
  • Kidney function is more likely to improve than worsen at hospital discharge after TAVR.

Keywords:
acute kidney injurycardiorenal syndromechronic kidney diseasetranscatheter aortic valve

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