title: Early safety outcome following transcatheter aortic valve implantation: is the amount of contrast media used a matter of concern?
abstract: OBJECTIVE
  The study objective was to evaluate the impact of the amount of contrast medium used for transcatheter aortic valve implantation (TAVI) on short-term outcome. Patients undergoing TAVI are exposed to repeat contrast medium application both for preprocedural screening and during the TAVI procedure itself. Whether the amount of contrast media is associated with worse outcome is unclear.
  
  
  METHODS
  A total of 257 patients were included (median age 82.7 years) and divided into two groups with preserved and reduced kidney function (glomerular filtration rate <60 ml/min/1.73 m2), respectively. Total volume of contrast media administered during and within 5 days prior to TAVI was analysed. A combined early safety endpoint at 30 days was evaluated.
  
  
  RESULTS
  The early safety endpoint was reached by 31 patients and acute kidney injury occurred in 22 patients. The median total volume of contrast media administered was 144 ml (interquartile range 81-225 ml). The amount of contrast did not independently predict the early safety endpoint in the overall population (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.56 to 1.53, p = 0.774) and in subgroups with preserved and reduced kidney function. Change in creatinine was an independent strong predictor of the early safety endpoint in the overall population (OR 18.13, 95% CI 4.70 to 69.99, p <0.001), as well as in subgroups with preserved and reduced kidney function. The amount of contrast did not predict a change in creatinine within 72 hours following TAVI (r = 0.02, 95% CI -0.02 to 0.07, p = 0.368).
  
  
  CONCLUSIONS
  Decreased kidney function after TAVI influences outcome. When rather small amounts of contrast media are used for screening and the TAVI procedure itself, the amount of contrast media seems not to be an independent predictor of outcome, further suggesting that decreased kidney function after TAVI is multifactorial.
authors.affiliation: Department of Cardiology, University Heart Centre, Zurich, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Vontobel
authors.affiliation: Department of Cardiology, University Heart Centre, Zurich, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Possner
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, Medical University Hospital Aarau, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schütz
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, Medical University Hospital Aarau, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Müller
authors.affiliation: Cardiac Surgery, University Heart Centre, Zurich, Switzerland.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.affiliation: Department of Cardiology, University Heart Centre, Zurich, Switzerland.
authors.forename: Roland K
authors.initials: RK
authors.lastname: Binder
authors.affiliation: Department of Cardiology, University Heart Centre, Zurich, Switzerland.
authors.forename: Sabine
authors.initials: S
authors.lastname: Haueis
authors.affiliation: Department of Cardiology, University Heart Centre, Zurich, Switzerland.
authors.forename: Adrian
authors.initials: A
authors.lastname: Attinger-Toller
authors.affiliation: Cardiac Surgery, University Heart Centre, Zurich, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.affiliation: Department of Cardiology, University Heart Centre, Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects; D015897:Comorbidity; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000032:analysis; D005260:Female; D005919:Glomerular Filtration Rate; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D003404:Creatinine