- 期刊
- OpenAccess
Impact of Transcatheter Aortic Valve Replacement on Severe Aortic Stenosis with Chronic Kidney Disease
摘要
Introduction: We hypothesize that although patients with chronic kidney disease (CKD) are at risk of short- and long-term adverse outcomes following TAVR, the determinants of change in renal function and long-term clinical outcomes are not well defined and may be multifactorial. Methods: From January 2013 to December 2020, a total of 380 consecutive patients with severe valvular aortic stenosis (AS), who had been referred to the TAVR multidisciplinary team, were recruited. The study excluded patients with end-stage renal disease requiring chronic dialysis (N=31). Procedural and clinical outcomes of all patients were followed up by the heart valve team according to the Valve Academic Research Consortium-2 consensus document. Results: Compared to patients without CKD and patients with CKD stage 1-2, patients with CKD stage 3-5 were significantly older (P<0.001), had more comorbidities, poor baseline clinical status and significantly higher Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score (P<0.001) and frailty score (P<0.001). The three groups showed no significant difference in device or procedural success rates. Acute kidney injury (AKI) was documented for 19.0%, renal function improvement for 5.7%, and unchanged renal function for 75.3% of the global cohort. Significantly more patients with CKD stage 3-5 at baseline suffered from AKI after TAVR (no CKD vs. CKD stage 1-2 vs. CKD stage 3-5 = 20% vs. 13% vs. 25%, respectively, P= 0.027) and renal function improvement (no CKD vs. CKD stage 1-2 vs. CKD stage 3-5 = 0% vs. 0% vs. 13%, respectively, P<0.001). Multivariate analysis revealed that higher baseline STS-PROM and frailty score, the presence of peripheral vascular disease and the need for emergency hemodynamic support during TAVR were independent predictors of developing AKI; while higher baseline STS-PROM and frailty score, the presence of 30-day stroke or major vascular access complications independently predicted long-term adverse outcomes. Conclusions: Our data demonstrated that in patients with CKD and AS undergoing TAVR, renal function was more likely to stay the same or improve, rather than worsen. Perhaps it is not the renal disease per se, but the accompanying comorbidities and the presence of periprocedural complications that drive the development of AKI and adverse outcomes after TAVR.