Abstract
Advanced chronic kidney disease (CKD) is associated with poor outcomes in patients who underwent surgical aortic valve replacement, whereas its prognostic role in transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to investigate outcomes in patients with advanced CKD who underwent TAVI. A total of 1,904 consecutive patients who underwent balloon-expandable TAVI in 33 centers between 2007 and 2012 were enrolled in the Italian Transcatheter Balloon-Expandable Valve Implantation Registry. Advanced CKD was defined according to the estimated glomerular filtration rate: 15 to 29 ml/min/1.73 m2 stage 4 (S4), <15 ml/min/1.73 m2 stage 5 (S5). Edwards Sapien or Sapien-XT prosthesis were used. The primary end point was all-cause mortality during follow-up. Secondary end points were major adverse cardiac events at 30 days and at follow-up, defined with Valve Academic Research Consortium 2 criteria. A total of 421 patients were staged S5 (n = 74) or S4 (n = 347). S5 patients were younger and had more frequently porcelain aorta and a lower incidence of previous stroke. Periprocedural and 30-day outcomes were similar in S5 and S4 patients. During 670 (±466) days of follow-up, S5 patients had higher mortality rates (69% vs 39%, p <0.01) and cardiac death (19% vs 9%, p = 0.02) compared with S4 patients. Male gender (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.2 to 2.2), left ventricular ejection fraction <30% (HR 2.3, 95% CI 1.3 to 4), atrial fibrillation (HR 1.4, 95% CI 1.0 to 1.9), and S5 CKD (HR 1.5, 95% CI 1.0 to 2.1) were independent predictors of death. In conclusion, TAVI in predialytic or dialytic patients (i.e., S5) is independently associated with poor outcomes with more than double risk of death compared with patients with S4 renal function. Conversely, in severe CKD (i.e., S4) a rigorous risk stratification is required to avoid the risk of futility risk.
| Original language | English |
|---|---|
| Pages (from-to) | 1438-1442 |
| Number of pages | 5 |
| Journal | American Journal of Cardiology |
| Volume | 119 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - May 1 2017 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Transcatheter Aortic Valve Implantation in Patients With Advanced Chronic Kidney Disease. / Conrotto, Federico; Salizzoni, Stefano; Andreis, Alessandro; D'Ascenzo, Fabrizio; D'Onofrio, Augusto; Agrifoglio, Marco; Chieffo, Alaide; Colombo, Antonio; Rapetto, Filippo; Santini, Francesco; Tarantini, Giuseppe; Gabbieri, Davide; Savini, Carlo; Immè, Sebastiano; Ribichini, Flavio; Valsecchi, Orazio; Aiello, Marco; Lixi, Giovanni; Iadanza, Alessandro; Pompei, Esmeralda; Stolcova, Miroslava; Ornaghi, Diego; Minati, Alessandro; Cassese, Mauro; Martinelli, Gian Luca; Sbarra, Pierluigi; Agostinelli, Andrea; Audo, Andrea; Pieroni, Andrea; Fiorilli, Rosario; Gerosa, Gino; Rinaldi, Mauro; Gaita, Fiorenzo.
In: American Journal of Cardiology, Vol. 119, No. 9, 01.05.2017, p. 1438-1442.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Transcatheter Aortic Valve Implantation in Patients With Advanced Chronic Kidney Disease
AU - Conrotto, Federico
AU - Salizzoni, Stefano
AU - Andreis, Alessandro
AU - D'Ascenzo, Fabrizio
AU - D'Onofrio, Augusto
AU - Agrifoglio, Marco
AU - Chieffo, Alaide
AU - Colombo, Antonio
AU - Rapetto, Filippo
AU - Santini, Francesco
AU - Tarantini, Giuseppe
AU - Gabbieri, Davide
AU - Savini, Carlo
AU - Immè, Sebastiano
AU - Ribichini, Flavio
AU - Valsecchi, Orazio
AU - Aiello, Marco
AU - Lixi, Giovanni
AU - Iadanza, Alessandro
AU - Pompei, Esmeralda
AU - Stolcova, Miroslava
AU - Ornaghi, Diego
AU - Minati, Alessandro
AU - Cassese, Mauro
AU - Martinelli, Gian Luca
AU - Sbarra, Pierluigi
AU - Agostinelli, Andrea
AU - Audo, Andrea
AU - Pieroni, Andrea
AU - Fiorilli, Rosario
AU - Gerosa, Gino
AU - Rinaldi, Mauro
AU - Gaita, Fiorenzo
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Advanced chronic kidney disease (CKD) is associated with poor outcomes in patients who underwent surgical aortic valve replacement, whereas its prognostic role in transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to investigate outcomes in patients with advanced CKD who underwent TAVI. A total of 1,904 consecutive patients who underwent balloon-expandable TAVI in 33 centers between 2007 and 2012 were enrolled in the Italian Transcatheter Balloon-Expandable Valve Implantation Registry. Advanced CKD was defined according to the estimated glomerular filtration rate: 15 to 29 ml/min/1.73 m2 stage 4 (S4), <15 ml/min/1.73 m2 stage 5 (S5). Edwards Sapien or Sapien-XT prosthesis were used. The primary end point was all-cause mortality during follow-up. Secondary end points were major adverse cardiac events at 30 days and at follow-up, defined with Valve Academic Research Consortium 2 criteria. A total of 421 patients were staged S5 (n = 74) or S4 (n = 347). S5 patients were younger and had more frequently porcelain aorta and a lower incidence of previous stroke. Periprocedural and 30-day outcomes were similar in S5 and S4 patients. During 670 (±466) days of follow-up, S5 patients had higher mortality rates (69% vs 39%, p <0.01) and cardiac death (19% vs 9%, p = 0.02) compared with S4 patients. Male gender (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.2 to 2.2), left ventricular ejection fraction <30% (HR 2.3, 95% CI 1.3 to 4), atrial fibrillation (HR 1.4, 95% CI 1.0 to 1.9), and S5 CKD (HR 1.5, 95% CI 1.0 to 2.1) were independent predictors of death. In conclusion, TAVI in predialytic or dialytic patients (i.e., S5) is independently associated with poor outcomes with more than double risk of death compared with patients with S4 renal function. Conversely, in severe CKD (i.e., S4) a rigorous risk stratification is required to avoid the risk of futility risk.
AB - Advanced chronic kidney disease (CKD) is associated with poor outcomes in patients who underwent surgical aortic valve replacement, whereas its prognostic role in transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to investigate outcomes in patients with advanced CKD who underwent TAVI. A total of 1,904 consecutive patients who underwent balloon-expandable TAVI in 33 centers between 2007 and 2012 were enrolled in the Italian Transcatheter Balloon-Expandable Valve Implantation Registry. Advanced CKD was defined according to the estimated glomerular filtration rate: 15 to 29 ml/min/1.73 m2 stage 4 (S4), <15 ml/min/1.73 m2 stage 5 (S5). Edwards Sapien or Sapien-XT prosthesis were used. The primary end point was all-cause mortality during follow-up. Secondary end points were major adverse cardiac events at 30 days and at follow-up, defined with Valve Academic Research Consortium 2 criteria. A total of 421 patients were staged S5 (n = 74) or S4 (n = 347). S5 patients were younger and had more frequently porcelain aorta and a lower incidence of previous stroke. Periprocedural and 30-day outcomes were similar in S5 and S4 patients. During 670 (±466) days of follow-up, S5 patients had higher mortality rates (69% vs 39%, p <0.01) and cardiac death (19% vs 9%, p = 0.02) compared with S4 patients. Male gender (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.2 to 2.2), left ventricular ejection fraction <30% (HR 2.3, 95% CI 1.3 to 4), atrial fibrillation (HR 1.4, 95% CI 1.0 to 1.9), and S5 CKD (HR 1.5, 95% CI 1.0 to 2.1) were independent predictors of death. In conclusion, TAVI in predialytic or dialytic patients (i.e., S5) is independently associated with poor outcomes with more than double risk of death compared with patients with S4 renal function. Conversely, in severe CKD (i.e., S4) a rigorous risk stratification is required to avoid the risk of futility risk.
UR - http://www.scopus.com/inward/record.url?scp=85015447270&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85015447270&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2017.01.042
DO - 10.1016/j.amjcard.2017.01.042
M3 - Article
C2 - 28325569
AN - SCOPUS:85015447270
VL - 119
SP - 1438
EP - 1442
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 9
ER -