E-viri
Recenzirano
-
Conrotto, Federico, MD; Salizzoni, Stefano, MD; Andreis, Alessandro, MD; D’Ascenzo, Fabrizio, MD; D’Onofrio, Augusto, MD; Agrifoglio, Marco, MD; Chieffo, Alaide, MD; Colombo, Antonio, MD; Rapetto, Filippo, MD; Santini, Francesco, MD; Tarantini, Giuseppe, MD; Gabbieri, Davide, MD; Savini, Carlo, MD; Immè, Sebastiano, MD; Ribichini, Flavio; Valsecchi, Orazio, MD; Aiello, Marco, MD; Lixi, Giovanni, MD; Iadanza, Alessandro, MD; Pompei, Esmeralda, MD; Stolcova, Miroslava, MD; Ornaghi, Diego, MD; Minati, Alessandro, MD; Cassese, Mauro, MD; Martinelli, Gian Luca, MD; Sbarra, Pierluigi, MD; Agostinelli, Andrea, MD; Audo, Andrea, MD; Pieroni, Andrea, MD; Fiorilli, Rosario, MD; Gerosa, Gino, MD; Rinaldi, Mauro, MD; Gaita, Fiorenzo, MD
The American journal of cardiology, 05/2017, Letnik: 119, Številka: 9Journal Article
Abstract Advanced chronic kidney disease (CKD) is associated with poor outcomes in patients undergoing surgical aortic valve replacement while its prognostic role in transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to investigate outcomes in patients with advanced CKD undergoing TAVI. 1904 consecutive patients undergoing balloon-expandable TAVI in 33 centers between 2007-2012 were enrolled in the I talian T ranscatheter Balloon- E xpandable Valve Implantation R egistry (ITER). Advanced CKD was defined according to estimated glomerular filtration rate (eGFR): 15-29 mL/min/1.73m2 stage 4 (S4), <15 mL/min/1.73m2 stage 5 (S5). Edwards Sapien or Sapien-XT prosthesis were used. Primary end-point was all-cause mortality during follow-up. Secondary end-points were 30-days and FU major-adverse-cardiac-events (MACE), defined with VARC-2 criteria. 421 patients were staged S5 (n=74) or S4 (n=347). S5 patients were younger, had more frequently porcelain aorta and lower incidence of previous stroke. Peri-procedural and 30-days outcomes were similar in S5 and S4 patients. During a 670 (±466) days of FU, S5 patients suffered higher mortality rates (69% vs. 39%, p<0.01) and cardiac death (19% vs. 9%, p=0.02) compared to S4. Male sex (HR 1.6, 95%CI 1.2-2.2), LVEF<30% (HR 2.3, 95% CI: 1.3-4), atrial fibrillation (HR 1.4, 95%CI:1.0-1.9) and S5 CKD (HR 1.5, 95%CI: 1.0-2.1) were independent predictors of death. In conclusion, TAVI in pre-dialytic or dialytic patients (i.e. S5) is independently associated with poor outcomes with more than double risk of death compared to patients with stage 4 renal function. Conversely, in severe CKD (i.e. S4) a rigorous risk stratification is required to avoid the risk of futility risk.
