TCT-328 Improvement of TAVR Patient Outcome Kim, Won-Keun; Woitek, Felix; Kiefer, Philipp ...
Journal of the American College of Cardiology,
11/2021, Letnik:
78, Številka:
19
Journal Article
Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) increases morbidity and mortality. Our study aimed to investigate the role of baseline N-terminal pro B-type natriuretic ...peptide (NT-proBNP) as a predictor of AKI following TAVI.
All consecutive TAVI patients were included in the analysis, except patients with dialysis and those with a GFR < 15 ml/min/1.73 m2 at baseline. Rates of AKI after TAVI were assessed according to the updated valve academic research consortium definitions using AKIN classification in three stages. NT-proBNP was measured at baseline. One-year mortality rates were assessed.
We included 1973 patients treated with TAVI between January 2006 and December 2016. Median IQR age was 81.0 77.0;84.0 years, the STS score was 6.2 3.9;9.0, and the logEuroScore was 14.5 9.0;23.0. 30-day and one-year mortality was 5.1 % and 16.1 % for all patients, respectively. Multivariate analysis revealed that patients with NT-proBNP levels higher than two times above the upper level of normal (ULN) had an increased risk for AKI after TAVI compared to patients with NT-proBNP levels < 2× ULN (OR 1.40 1.03–1.91).
Routine assessment of baseline NT-proBNP levels might be an additional tool to identify patients at increased risk for AKI after TAVI.
•Acute kidney injury is associated with adverse outcomes in TAVI patients.•Baseline NT-proBNP is an independent predictor of AKI after TAVI.•Early identification of patients at high risk for AKI is crucial.•High-risk patients may benefit from further reducing the periprocedural amount of CM.
The use of bioprostheses for surgical aortic valve replacement increased substantially within the last years. In case of prosthesis failure, re-SAVR is standard of care, whereas valve-in-valve ...deployment of a transfemoral transcatheter aortic valve prosthesis (VinV-TFAVI) has recently emerged as an alternative. We sought to evaluate early safety, clinical efficacy, and all-cause 1-year-mortality of VinV-TFAVI and redo surgery for failing aortic bioprostheses (re-SAVR).
Patients receiving either VinV-TFAVI (n = 147) or re-SAVR (n = 111) for a degenerated aortic bioprosthesis between 01/2006 and 05/2017 were included in this analysis. All-cause 1-year mortality was the primary outcome measure. Early safety and clinical efficacy according to VARC-2 endpoint definitions were evaluated at 30 days.
Baseline characteristics differed significantly between both groups including age, STS-PROM, and incidence of relevant comorbidities. Re-stenosis was the predominant mode of failure in 45.9% of re-SAVR and 63.1% of VinV-TFAVI patients. The rate of “early safety” endpoints was lower with VinV-TFAVI (17.7% vs. 64.9%, p < 0.01), the rate of “clinical efficacy” endpoints was lower, e.g. better with re-SAVR (53.1% vs. 32.4%, p < 0.01). All-cause 1-year-mortality (VinV-TFAVI 8.8% vs re-SAVR 9.9%, p = 0.84) was not different. Treatment strategy was not associated with 1-year-mortality in a Cox regression analysis. The incidence of prosthesis-patient-mismatch was higher in VinV-TFAVI compared to re-SAVR.
VinV-TFAVI represents a viable alternative for treatment of degenerated aortic bioprostheses in patients at increased surgical risk. However, in patients at low risk for reoperation, a better clinical efficacy and acceptable safety may favour re-SAVR.
•VinV-TAVI is a safe and effective treatment for degenerated aortic bioprosthesis.•Data comparing this procedure to redo surgery (re-SAVR) are scarce.•Comparable 1-year-mortality between re-SAVR and VinV-TFAVI.•Incidence of bleeding and renal failure was higher with re-SAVR.•Postoperative transvalvular gradients were higher after VinV-TFAVI.
Higher B-type natriuretic peptide (BNP) levels are known to be associated with acute kidney injury (AKI) in patients after acute myocardial infarction.
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