The impact of transcatheter aortic valve implantation planning and procedure on acute and chronic renal failure

Abstract

Background: Severe aortic valve stenosis inhibits renal perfusion, thereby potentially worsening renal function, in particular in elderly patients most often assigned to transcatheter aortic valve implantation (TAVI). Pre-TAVI diagnostics and the procedure itself may adversely impact renal function, however renal perfusion and function may also improve postprocedure. This study aimed to clarify the impact of TAVI planning and procedure on kidney function Methods: In this retrospective study, kidney function of patients who underwent transfemoral TAVI at a tertiary university hospital between 2016 and 2019 was analyzed. The present study investigated kidney function at baseline, after computed tomography (CT) was performed for evaluation of TAVI, after TAVI, at discharge and at follow-up.Results: Among 366 patients, the prevalence of acute kidney injury (AKI) was 14.5% after TAVI. Independent predictors of AKI were arterial hypertension, baseline creatinine, AKI post CT and coronary intervention during pre-procedural diagnostics. At discharge and follow-up, 2.1% and 3.4%, respectively had sustained relevant impairment of kidney function (defined as creatinine/baseline creatinine > 1.5 or renal replacement therapy). Patients with known chronic kidney disease showed no higher rates of short-and long-term impairment, but higher rates of improvement of renal function after TAVI. Conclusions:In most cases TAVI does not worsen renal function. A sustained impairment after TAVI was found in only a few cases. This was independent of reduced baseline kidney function. Transfemoral TAVI can thus be planned and performed even in patients with higher stages of chronic kidney disease.

Zero-contrast imaging for the assessment of transcatheter aortic valve implantation in candidates with renal dysfunction

“…It is widely acknowledged that the use of contrast agents can result in a deterioration of renal function, particularly in certain subsets of clinical scenarios. Despite the widespread use of angiographic contrast-based methods in pre-TAVI evaluations, the occurrence of acute kidney injury (AKI) in this specific context has been underreported [ 7 , 8 ]. Nonetheless, everyday practice and common sense indicate that it is a significant clinical concern that warrants further attention.…”