Moderate and Severe Preoperative Chronic Kidney Disease Worsen Clinical Outcomes After Transcatheter Aortic Valve Implantation

Abstract

T ranscatheter aortic valve implantation (TAVI) has emerged as an alternative to surgery therapy for severe aortic stenosis.1,2 The detrimental impact of baseline chronic kidney disease (CKD) on worsening the prognosis of patients undergoing surgical aortic valve replacement is well established. 3,4 Conversely, this remains a debated issue in patients undergoing TAVI.Mixed evidences are available regarding the relationship between baseline CKD and clinical outcomes in TAVI, and patients with CKD were typically under-represented in TAVI trials. On the other hand, CKD showed to be an independent predictor of mortality at 1-year after TAVI in some registries, [5][6][7][8] but not in others. 9 The degree of CKD, which exposes to the highest risk is also a matter of debate: recent data suggest that CKD stage 4 and 5, but not stage 3, are predictors of 30-day and late mortality after TAVI.10,11 Finally, cross-sectional studies failed to show a significant impact of CKD on mortality. 12,13 On this background, given the contrasting evidence and the latest literature in this field, there is a clinical and scientific rationale to investigate the impact of preoperative CKD on the clinical outcomes of patients undergoing TAVI. Methods Study SelectionThe study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses requirements. MEDLINE, Cochrane, ISI Web of Science, and SCOPUS databases were searched Background-There is a conflicting evidence on safety and efficacy of transcatheter aortic valve implantation in patients with preoperative chronic kidney disease (CKD). Therefore, we conducted a meta-analysis on the impact of CKD on outcomes after transcatheter aortic valve implantation. Methods and Results-Nine

Diabetes mellitus is associated with increased acute kidney injury and 1‐year mortality after transcatheter aortic valve replacement: A meta‐analysis

“…Currently, TAVR is a treatment modality for patients with severe aortic stenosis, especially those who are at prohibitive or high surgical risk . A number of comorbid conditions have been associated with increased morbidity and mortality after TAVR . However, there are contradicting data on the impact of DM on post‐TAVR outcomes.…”

“…16,17 A number of comorbid conditions have been associated with increased morbidity and mortality after TAVR. [18][19][20][21] However, there are contradicting data on the impact of DM on post-TAVR outcomes.…”

2018 AATS/ACC/SCAI/STS expert consensus systems of care document: Operator and institutional recommendations and requirements for transcatheter aortic valve replacement

“…Utilization of palliative care consultants is helpful. Progress has been made in identifying patient characteristics that are statistically associated with markedly limited life expectancy and lower likelihood of functional benefit after TAVR . No single one of these factors clearly supports denial of TAVR as an option, but they inform the decision process and discussion with the patient and family. These characteristics include end‐stage renal disease or dialysis, advanced lung disease (especially if oxygen dependent), slow ambulation (6 min walk time < 150 m), atrial fibrillation, poor LV systolic function (LV ejection fraction <30%, LV stroke volume index ≤35 mL/m 2 , impaired contractile reserve with dobutamine stress echocardiography), low aortic gradient, pulmonary hypertension, severe organic mitral regurgitation, and STS–Predicted Risk of Mortality (PROM) score > 15% . Advanced dementia and impaired cognitive ability, active cancer, marked musculoskeletal disability, debilitating frailty, and severe cachexia and sarcopenia (low body mass index) are other obvious conditions for which TAVR procedural denial may be appropriate.…”

Transcatheter Aortic Valve Replacement: 2015 in Review

“…Co-Morbid Conditions as Predictors of Prognosis After TAVR. Multiple baseline co-morbid conditions have been associated with poor outcome after TAVR including frailty, 56 poor nutritional status, both moderate and severe preoperative chronic kidney disease, 11,57,58 dialysis and severe lung disease. TAVR is associated with a significant improvement of pulmonary function, most evident in patients with moderate and severe pulmonary dysfunction.…”