title: Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes and prognostic markers from a large cohort of patients.
abstract: OBJECTIVE
  The aim of this study was to determine the effects of advanced chronic kidney disease (CKD) on early and late outcomes after transcatheter aortic valve implantation (TAVI), and to evaluate the predictive factors of poorer outcomes in such patients.
  
  
  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 m(2); n = 950), stage 3 (30-59 mL/min/1.73 m(2); n = 924), stage 4 (15-29 mL/min/1.73 m(2); 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 non-cardiovascular 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 CKD patients, 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 in NYHA class (P < 0.001) and no deterioration in valve hemodynamics (P = NS for changes in mean gradient and valve area over time).
  
  
  CONCLUSIONS
  Advanced CKD was associated with a higher rate of early and late mortality and bleeding events following TAVI, with AF and dialysis therapy determining a higher risk in these patients. The mortality rate of patients with both factors was unacceptably high and this should be taken into account in the clinical decision-making process in this challenging group of patients.
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Allende
authors.affiliation: St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.affiliation: Hospital Universitario Virgen de la Victoria, Malaga, Spain.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Munoz-Garcia
authors.affiliation: Thoraxcenter-Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: de Jaegere
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Angiografia de Occidente S.A., Cali, Colombia.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Dager
authors.affiliation: St-Michael's Hospital, Toronto, ON, Canada.
authors.forename: Asim
authors.initials: A
authors.lastname: Cheema
authors.affiliation: Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Vicenç
authors.initials: V
authors.lastname: Serra
authors.affiliation: Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Amat-Santos
authors.affiliation: Hamilton General Hospital, Hamilton, ON, Canada.
authors.forename: James L
authors.initials: JL
authors.lastname: Velianou
authors.affiliation: St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.affiliation: Hospital Universitario Virgen de la Victoria, Malaga, Spain.
authors.forename: Juan H
authors.initials: JH
authors.lastname: Alonso-Briales
authors.affiliation: Thoraxcenter-Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Rutger-Jan
authors.initials: RJ
authors.lastname: Nuis
authors.affiliation: Thoraxcenter-Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Elhamula
authors.initials: E
authors.lastname: Faqiri
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Imme
authors.affiliation: Angiografia de Occidente S.A., Cali, Colombia.
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Benitez
authors.affiliation: Angiografia de Occidente S.A., Cali, Colombia.
authors.forename: Angela Maria
authors.initials: AM
authors.lastname: Cucalon
authors.affiliation: St-Michael's Hospital, Toronto, ON, Canada.
authors.forename: Hatim
authors.initials: H
authors.lastname: Al Lawati
authors.affiliation: Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: Garcia del Blanco
authors.affiliation: Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Lopez
authors.affiliation: Hamilton General Hospital, Hamilton, ON, Canada.
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Natarajan
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: DeLarochellière
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada.
authors.forename: Henrique B
authors.initials: HB
authors.lastname: Ribeiro
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec city, QC, Canada josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality; D020521:Stroke / Q000209:etiology / Q000401:mortality; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: Atrial fibrillation; Chronic kidney disease; Dialysis; Transcatheter aortic valve implantation