30 days and midterm outcomes of patients undergoing percutaneous replacement of aortic valve according to their renal function: a multicenter study.
BACKGROUND
Chronic kidney disease (CKD) constitutes a predictor of adverse events for surgical aortic valve replacement. In patients undergoing TAVI no study was performed to evaluate outcomes according to renal clearance, which represents the most accurate instrument to assess kidney function.


METHODS
From January 2007 to December 2011 all TAVI patients of our institutions were prospectively divided into 3 cohorts. Preserved renal function those with clearance more or equal to 60 ml/min/1.73 m2, moderate CKD those between 30 and 60, and severe CKD those between 15 and 30. Patients with a clearance less than 15 or in dialysis were excluded. All outcomes were adjudicated according to VARC criterion.


RESULTS
72 patients with preserved renal function, 219 with moderate and 73 with severe CKD were included; those in the latter group were older and with lower ejection fraction. At 30 days, severe CKD was associated with a trend toward a higher risk of major events than preserved and moderate CKD: cardiovascular death (2.8% vs 6.7% vs 9%; p=0.256) life threatening bleedings (10% vs 10% vs 16%; p=0.384), major stroke (1.4% vs 2.3% vs 4.1%; p=0.763). At a medium follow-up of 540 ± 250 days, cardiovascular death incidence was higher in patients with severe CKD (7% vs 8 vs 19%; p<0.0001), however this difference was not consistently significant after multivariable adjustment (p=0.300). Overall, 2% of patients developed kidney failure, whereas 47.1% of patients with severe CKD improved to moderate renal impairment.


CONCLUSIONS
Patients with severe chronic renal disease presented higher risk of adverse events, mainly driven by increased hazard of bleedings. TAVI procedures could offer kidney functional improvement in an important subset of patients.
Division of Cardiology, San Giovanni Battista Molinette, University of Turin, Turin, Italy.
Fabrizio
F
D'Ascenzo
Claudio
C
Moretti
Stefano
S
Salizzoni
Mario
M
Bollati
Maurizio
M
D'Amico
Flavia
F
Ballocca
Francesca
F
Giordana
Marco
M
Barbanti
Gian Paolo
GP
Ussia
Nedy
N
Brambilla
Francesco
F
Bedogni
Giuseppe
G
Biondi Zoccai
Corrado
C
Tamburino
Fiorenzo
F
Gaita
Imad
I
Sheiban
D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007668:Kidney / Q000502:physiology*; D008297:Male; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome