Prognostic Impact of Residual Renal Congestion at Discharge After Transcatheter Aortic Valve Implantation

Residual pulmonary congestion after transcatheter aortic valve implantation (TAVI) has been linked to adverse outcomes. However, whether renal congestion, assessed by intrarenal venous flow (IRVF), is associated with outcomes remains unclear.

This study enrolled 164 patients with aortic stenosis who underwent TAVI, and assessed IRVF before TAVI and at discharge (48-72 hours before discharge). The IRVF patterns were categorized as continuous (non-congestive) or discontinuous (congestive). The primary endpoint was a composite of all-cause death or heart failure rehospitalization.

Before TAVI, 126 patients (76.8%) had a continuous pattern, and 38 (23.2%) had a discontinuous pattern; at discharge, the numbers were 134 (81.7%) and 30 (18.3%), respectively. Over a median follow-up of 698 days, the primary endpoint occurred in 37 patients (22.6%). A discontinuous pattern at discharge was associated with a higher incidence of events than a continuous pattern (log-rank P = 0.005), whereas the pre-TAVI IRVF pattern did not stratify risk. In an analysis of changes in IRVF patterns (continuous-continuous, continuous-discontinuous, discontinuous-continuous, and discontinuous-discontinuous), event rates were 20 of 114 (17.5%), 5 of 12 (41.7%), 4 of 20 (20.0%), and 8 of 18 (44.4%), respectively, and the risk was higher in patients discharged with a discontinuous pattern-continuous-discontinuous (hazard ratio [HR], 3.26, 95% confidence interval [CI] 1.19-8.92; P = 0.022) and discontinuous-discontinuous (HR, 2.34, 95% CI 1.08-5.37; P = 0.045)-compared with those in the continuous-continuous group.

A discontinuous IRVF pattern at discharge, indicating residual renal congestion after TAVI, was associated with an adverse prognosis.