Acute Kidney Recovery in Patients Who Underwent Transcatheter Versus Surgical Aortic Valve Replacement (from the Northern New England Cardiovascular Disease Study Group)

Lahoud, Rony; Butzel, David; Parsee, Anahita; Huang, Yi‐Ling; Solomon, Richard; DeVries, James T.; Flynn, James M.; Iribarne, Alexander; Lee, Peter Ver; Ross, Cathy S.; Malenka, David J.; Dauerman, Harold L.

doi:10.1016/j.amjcard.2019.11.024

Cited by 13 publications

(16 citation statements)

References 28 publications

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“…To our knowledge, however, our data are the first to identify BMI as a modifier of the association between AKI-TAVR and mortality, whereas an effect of BMI on the incidence of postcardiac surgery (and especially surgical aortic valve replacement) AKI and its effect on mortality has been already demonstrated 27 . Very recently, and in line with our data, Lahoud et al 28 demonstrated better recovery of kidney function for obese (defined as BMI > 30 kg/m 2 ) patients who underwent TAVR, with a beneficial impact on mortality.…”

Section: Discussionsupporting

confidence: 87%

BMI and acute kidney injury post transcatheter aortic valve replacement: unveiling the obesity paradox

Marzo

Benenati

Buscaglia

et al. 2021

Journal of Cardiovascular Medicine

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Aims Acute kidney injury (AKI) may complicate transcatheter aortic valve replacement (TAVR) leading to higher mortality. The relationship between AKI, obesity, and mortality, however, is controversial. We sought to investigate the impact of body habitus on the prognostic value of AKI in TAVR. Methods Among the 645 patients who underwent successful TAVR in a single high-volume centre, we retrospectively evaluated the association between AKI-TAVR and 30-day, 6-month, and 1-year mortality, and whether this relationship was affected by BMI. AKI was defined according to the Valve Academic Research Consortium-2 criteria. Patients were categorized into three groups by BMI: low-to-normal weight (<25 kg/m2), overweight (25–30 kg/m2), obese (>30.0 kg/m2). Results Three-hundred and twenty-four (50.2%) patients were low-to-normal weight, 223 (34.6%) overweight, and 98 (15.2%) obese. AKI occurred in 141 (21.9%), similarly across BMI groups. Thirty-day, 6-month, and 1-year mortality rates were 2.2, 3.7, and 7.9%, without differences across BMI groups. Among patients who developed AKI-TAVR, 30-day (8.7 vs. 2.0 vs. 0.0%), 6-month (13.0 vs. 6.1 vs. 4.3%), and 1-year (20.3 vs. 12.2 vs. 4.3%) mortality showed a decreasing trend across increasing BMI categories (all P < 0.05); the same trend was not observed for patients without AKI-TAVR. In multivariate models, AKI was associated with 30-day [odds ratio (OR): 2.46, 95% confidence interval (CI): 1.70–8.67], 6-month (OR: 2.75, 95% CI: 1.32–7.59), and 1-year mortality (OR: 1.84, 95% CI: 1.22–3.71, all P < 0.05). The interaction between AKI and BMI, when added to the models, was consistently significant (all P < 0.05). Conclusion Higher BMI is associated with better survival in TAVR patients who develop AKI.

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Section: Discussionsupporting

confidence: 87%

BMI and acute kidney injury post transcatheter aortic valve replacement: unveiling the obesity paradox

Marzo

Benenati

Buscaglia

et al. 2021

Journal of Cardiovascular Medicine

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“…Acute kidney injury (AKI) is a matter of concern after SAVR and also after TAVI since the introduction of transcatheter procedures [ 25 ]. Some large studies [ 13 , 26 , 27 ] and meta-analyses [ 28 – 30 ] have shown a lower risk of postprocedural AKI with TAVI. In our analysis, although a significantly higher need for acute newly onset dialysis with SAVR was confirmed, the need for long-term dialysis was very low and similar with TAVI and SAVR.…”

Section: Discussionmentioning

confidence: 99%

Propensity matched comparison of TAVI and SAVR in intermediate-risk patients with severe aortic stenosis and moderate-to-severe chronic kidney disease: a subgroup analysis from the German Aortic Valve Registry

et al. 2022

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Objective We compared TAVI vs. SAVR in patients with moderate-to-severe chronic kidney disease (eGFR 15–60 ml/min/1.73 m2) for whom both procedures could possibly be considered (age ≤ 80 years, STS-score 4–8). Background According to both ACC/AHA and ESC/EACTS recent guidelines, aortic stenosis may be treated with either transcatheter (TAVI) or surgical (SAVR) aortic valve replacement in a subgroup of patients. A shared therapeutic decision is made by a heart team based on individual factors, including chronic kidney disease (CKD). Methods Data from the large nationwide German Aortic Valve Registry were used. A propensity score method was used to select 704 TAVI and 374 SAVR matched patients. Primary endpoint was 1-year survival. Secondary endpoints were clinical complications, including pacemaker implantation, vascular complications, myocardial infarction, bleeding, and the need for new-onset dialysis. Results One-year survival was similar (HR [95% CI] for TAVI 1.271 [0.795, 2.031], p = 0.316), with no divergence in Kaplan–Meier curves. In spite of post-procedural short-term survival being numerically higher for TAVI patients and 1-year survival being numerically higher for SAVR patients, such differences did not reach statistical significance (96.4% vs. 94.2%, p = 0.199, and 86.2% vs. 81.2%, p = 0.316, respectively). In weighted analyses, pacemaker implantation, vascular complications, and were significantly more common with TAVI; whereas myocardial infarction, bleeding requiring transfusion, and longer ICU-stay and overall hospitalization were higher with SAVR. Temporary dialysis was more common with SAVR (p < 0.0001); however, a probable need for chronic dialysis was rare and similar in both groups. Conclusion Both TAVI and SAVR led to comparable and excellent results in patients with moderate-to-severe CKD in an intermediate-risk population of patients with symptomatic severe aortic stenosis for whom both therapies could possibly be considered.

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“…After a strict appraisal, 21 studies including 12 propensity score-matched, 8 observational cohort studies, and 1 randomized controlled study were included. Except for 10 studies included in the previous meta-analysis, 2 missed studies and 9 recently published studies were included, 38,989 patients with advanced CKD were incorporated into the data synthesis (16,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40).…”

Section: Eligible Studiesmentioning

confidence: 99%

Transcatheter versus surgical aortic valve replacement in aortic stenosis patients with advanced chronic kidney disease: a systematic review and meta-analysis

Wei¹,

Zhang²,

Zhai³

et al. 2021

Ann Palliat Med

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Background: Transcatheter aortic valve replacement (TAVR) has been increasingly used in all levels of risk patients, which is less invasive and has fewer complications. However, the benefits of transcatheter and surgical methods of aortic valve replacement remain controversial for aortic stenosis (AS) patients with advanced chronic kidney disease (stage 3-5).Methods: We comprehensively searched PubMed, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) from January 2000 to October 2020 and performed a systematic review to evaluate the two techniques. Two investigators independently conducted the literature searches, study eligibility assessment, and data extraction in duplicate.Results: Compared to surgical aortic valve replacement (SAVR), TAVR had lower risk of in-hospital mortality [odds ratio (OR): 0.

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Acute Kidney Recovery in Patients Who Underwent Transcatheter Versus Surgical Aortic Valve Replacement (from the Northern New England Cardiovascular Disease Study Group)

Cited by 13 publications

References 28 publications

BMI and acute kidney injury post transcatheter aortic valve replacement: unveiling the obesity paradox

BMI and acute kidney injury post transcatheter aortic valve replacement: unveiling the obesity paradox

Propensity matched comparison of TAVI and SAVR in intermediate-risk patients with severe aortic stenosis and moderate-to-severe chronic kidney disease: a subgroup analysis from the German Aortic Valve Registry

Transcatheter versus surgical aortic valve replacement in aortic stenosis patients with advanced chronic kidney disease: a systematic review and meta-analysis

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