Transcatheter Aortic Valve Implantation in Patients With Advanced Chronic Kidney Disease

Federico Conrotto, Stefano Salizzoni, Alessandro Andreis, Fabrizio D'Ascenzo, Augusto D'Onofrio, Marco Agrifoglio, Alaide Chieffo, Antonio Colombo, Filippo Rapetto, Francesco Santini, Giuseppe Tarantini, Davide Gabbieri, Carlo Savini, Sebastiano Immè, Flavio Ribichini, Orazio Valsecchi, Marco Aiello, Giovanni Lixi, Alessandro Iadanza, Esmeralda PompeiMiroslava Stolcova, Diego Ornaghi, Alessandro Minati, Mauro Cassese, Gian Luca Martinelli, Pierluigi Sbarra, Andrea Agostinelli, Andrea Audo, Andrea Pieroni, Rosario Fiorilli, Gino Gerosa, Mauro Rinaldi, Fiorenzo Gaita

Research output: Contribution to journalArticlepeer-review

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 languageEnglish
Pages (from-to)1438-1442
Number of pages5
JournalAmerican Journal of Cardiology
Volume119
Issue number9
DOIs
Publication statusPublished - May 1 2017

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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