Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes and prognostic markers from a large cohort of patients
Open Access
- 5 May 2014
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 35 (38), 2685-2696
- https://doi.org/10.1093/eurheartj/ehu175
Abstract
The aim of this study was to determine the effects of advanced chronic kidney disease (CKD) on early and late outcomes after transcatheter aortic valve implantation (TAVI), and to evaluate the predictive factors of poorer outcomes in such patients. This was a multicentre study including a total of 2075 consecutive patients who had undergone TAVI. Patients were grouped according the estimated glomerular filtration rate as follows: CKD stage 1-2 (≥60 mL/min/1.73 m2; n = 950), stage 3 (30–59 mL/min/1.73 m2; n = 924), stage 4 (15–29 mL/min/1.73 m2; n = 134) and stage 5 (n = 67). Clinical outcomes were evaluated at 30-days and at follow-up (median of 15 [6–29] months) and defined according to the VARC criteria. Advanced CKD (stage 4–5) was an independent predictor of 30-day major/life-threatening bleeding (P = 0.001) and mortality (P = 0.027), and late overall, cardiovascular and non-cardiovascular mortality (P < 0.01 for all). Pre-existing atrial fibrillation (HR: 2.29, 95% CI: 1.47–3.58, P = 0.001) and dialysis therapy (HR: 1.86, 95% CI: 1.17–2.97, P = 0.009) were the predictors of mortality in advanced CKD patients, with a mortality rate as high as 71% at 1-year follow-up in those patients with these 2 factors. Advanced CKD patients who had survived at 1-year follow-up exhibited both a significant improvement in NYHA class (P < 0.001) and no deterioration in valve hemodynamics (P = NS for changes in mean gradient and valve area over time). Advanced CKD was associated with a higher rate of early and late mortality and bleeding events following TAVI, with AF and dialysis therapy determining a higher risk in these patients. The mortality rate of patients with both factors was unacceptably high and this should be taken into account in the clinical decision-making process in this challenging group of patients.This publication has 37 references indexed in Scilit:
- Prognostic Value of Chronic Kidney Disease After Transcatheter Aortic Valve ImplantationJournal of the American College of Cardiology, 2013
- The Impact of Specific Preoperative Organ Dysfunction in Patients Undergoing Aortic Valve ReplacementThe Annals of Thoracic Surgery, 2013
- Management of cardiovascular disease in patients with kidney diseaseNature Reviews Cardiology, 2013
- Impact of preoperative chronic kidney disease on short- and long-term outcomes after transcatheter aortic valve implantation: A Pooled-RotterdAm-Milano-Toulouse In Collaboration Plus (PRAGMATIC-Plus) initiative substudyAmerican Heart Journal, 2013
- Short- and long-term outcomes in patients undergoing valve surgery with end-stage renal failure receiving chronic hemodialysisThe Journal of Thoracic and Cardiovascular Surgery, 2012
- Chronic kidney diseaseThe Lancet, 2012
- Transcatheter aortic valve implantation: current and future approachesNature Reviews Cardiology, 2011
- Long-term Results of Mechanical and Biological Heart Valves in Dialysis and Non-Dialysis PatientsThe Thoracic and Cardiovascular Surgeon, 2011
- Renal Function as Predictor of Mortality in Patients After Percutaneous Transcatheter Aortic Valve ImplantationJACC: Cardiovascular Interventions, 2010
- Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patientsEuropean Journal of Cardio-Thoracic Surgery, 1999