Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation: Insights on clinical outcomes and prognostic markers froma large cohort of patients

Ricardo Allende, John G. Webb, Antonio J. Munoz-Garcia, Peter De Jaegere, Corrado Tamburino, Antonio E. Dager, Asim Cheema, Vicenç Serra, Ignacio Amat-Santos, James L. Velianou, Marco Barbanti, Danny Dvir, Juan H. Alonso-Briales, Rutger Jan Nuis, Elhamula Faqiri, Sebastiano Imme, Luis Miguel Benitez, Angela Maria Cucalon, Hatim Al Lawati, Bruno Garcia Del BlancoJavier Lopez, Madhu K. Natarajan, Robert DeLarochellière, Marina Urena, Henrique B. Ribeiro, Eric Dumont, Luis Nombela-Franco, Josep Rodés-Cabau

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Abstract

Aim Theaimof this studywastodeterminetheeffects ofadvancedchronic kidneydisease(CKD)onearlyandlateoutcomes after transcatheter aortic valve implantation (TAVI), and to evaluate the predictive factors of poorer outcomes in such patients. Methods and results This was a multicentre study including a total of 2075 consecutive patients who had undergone TAVI. Patients were grouped according the estimated glomerular filtration rate as follows: CKD stage 1-2 (≥60 mL/min/1.73 m2; n = 950), stage 3 (30-59 mL/min/1.73 m2; n= 924), stage 4 (15.29 mL/min/1.73 m2; n= 134) and stage 5 (,15 mL/ min/1.73 m2 or dialysis; n= 67). Clinical outcomes were evaluated at 30-days and at follow-up (median of 15 [6.29] months) and defined according to the VARC criteria. Advanced CKD (stage 4.5) was an independent predictor of 30-day major/life-threatening bleeding (P= 0.001) and mortality (P= 0.027), and late overall, cardiovascular and noncardiovascular mortality (P < 0.01 for all). Pre-existing atrial fibrillation (HR: 2.29, 95% CI: 1.47.3.58, P= 0.001) and dialysis therapy (HR: 1.86, 95% CI: 1.17.2.97, P= 0.009)were the predictors of mortality in advanced CKDpatients, with a mortality rate as high as 71% at 1-year follow-up in those patients with these 2 factors. Advanced CKD patients who had survived at 1-year follow-up exhibited both a significant improvement inNYHAclass (P < 0.001) and no deterioration in valve hemodynamics (P= NS for changes in mean gradient and valve area over time). Conclusions AdvancedCKDwas associatedwith a higher rate of early and latemortality and bleeding events followingTAVI,with AFand dialysis therapy determining a higher risk in these patients. Themortality rate of patientswith both factorswas unacceptably high and this should be taken into account in the clinical decision-making process in this challenging group of patients.

Original languageEnglish
Pages (from-to)2685-2696
Number of pages12
JournalEuropean Heart Journal
Volume35
Issue number38
DOIs
Publication statusPublished - Oct 7 2014

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Keywords

  • Atrial fibrillation
  • Chronic kidney disease
  • Dialysis
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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