Transcatheter Aortic Valve Implantation in Patients With Advanced Chronic Kidney Disease.
Advanced chronic kidney disease (CKD) is associated with poor outcomes in patients who underwent surgical aortic valve replacement, whereas its prognostic role in transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to investigate outcomes in patients with advanced CKD who underwent TAVI. A total of 1,904 consecutive patients who underwent balloon-expandable TAVI in 33 centers between 2007 and 2012 were enrolled in the Italian Transcatheter Balloon-Expandable Valve Implantation Registry. Advanced CKD was defined according to the estimated glomerular filtration rate: 15 to 29 ml/min/1.73 m2stage 4 (S4), <15 ml/min/1.73 m2stage 5 (S5). Edwards Sapien or Sapien-XT prosthesis were used. The primary end point was all-cause mortality during follow-up. Secondary end points were major adverse cardiac events at 30 days and at follow-up, defined with Valve Academic Research Consortium 2 criteria. A total of 421 patients were staged S5 (n = 74) or S4 (n = 347). S5 patients were younger and had more frequently porcelain aorta and a lower incidence of previous stroke. Periprocedural and 30-day outcomes were similar in S5 and S4 patients. During 670 (±466) days of follow-up, S5 patients had higher mortality rates (69% vs 39%, p <0.01) and cardiac death (19% vs 9%, p = 0.02) compared with S4 patients. Male gender (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.2 to 2.2), left ventricular ejection fraction <30% (HR 2.3, 95% CI 1.3 to 4), atrial fibrillation (HR 1.4, 95% CI 1.0 to 1.9), and S5 CKD (HR 1.5, 95% CI 1.0 to 2.1) were independent predictors of death. In conclusion, TAVI in predialytic or dialytic patients (i.e., S5) is independently associated with poor outcomes with more than double risk of death compared with patients with S4 renal function. Conversely, in severe CKD (i.e., S4) a rigorous risk stratification is required to avoid the risk of futility risk.
Division of Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy. Electronic address: federico.conrotto@gmail.com.
Federico
F
Conrotto
Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
Stefano
S
Salizzoni
Division of Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
Alessandro
A
Andreis
Division of Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
Fabrizio
F
D'Ascenzo
Department of Cardiac, Thoracic and Vascular Sciences - University of Padua, Padua, Italy.
Augusto
A
D'Onofrio
Centro Cardiologico Monzino - Department of Clinical Sciences and Community, University of Milan, Milan, Italy.
Marco
M
Agrifoglio
Ospedale San Raffaele, Milan, Italy.
Alaide
A
Chieffo
Ospedale San Raffaele, Milan, Italy.
Antonio
A
Colombo
Divisione di Cardiochirurgia, IRCCS San Martino-IST, Genoa, Italy.
Filippo
F
Rapetto
Divisione di Cardiochirurgia, IRCCS San Martino-IST, Genoa, Italy.
Francesco
F
Santini
Department of Cardiac, Thoracic and Vascular Sciences - University of Padua, Padua, Italy.
Giuseppe
G
Tarantini
Hesperia Hospital, Modena, Italy.
Davide
D
Gabbieri
AOU Policlinico S. Orsola-Malpighi, Bologna, Italy.
Carlo
C
Savini
Ospedale Ferrarotto, Università di Catania, Catania, Italy.
Sebastiano
S
Immè
AOU Integrata Verona, Verona, Italy.
Flavio
F
Ribichini
AO Papa Giovanni XXIII, Bergamo, Italy.
Orazio
O
Valsecchi
IRCCS Policinico S. Matteo, Pavia, Italy.
Marco
M
Aiello
AO Brotzu, Cagliari, Italy.
Giovanni
G
Lixi
AOU Policlinico Le Scotte, Siena, Italy.
Alessandro
A
Iadanza
AOUD Santa Maria della Misericordia, Udine, Italy.
Esmeralda
E
Pompei
AOU Careggi, Florence, Italy.
Miroslava
M
Stolcova
Humanitas Research Hospital, Rozzano, Italy.
Diego
D
Ornaghi
Ospedale Cattinara, Trieste, Italy.
Alessandro
A
Minati
Clinica S. Maria, Bari, Italy.
Mauro
M
Cassese
Clinica S. Maria, Bari, Italy.
Gian Luca
GL
Martinelli
Division of Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
Pierluigi
P
Sbarra
Ospedale Maggiore, Parma, Italy.
Andrea
A
Agostinelli
AO Cesare Biagio e Arrigo, Alessandria, Italy.
Andrea
A
Audo
AOU Pisana, Pisa, Italy.
Andrea
A
Pieroni
Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
Rosario
R
Fiorilli
Department of Cardiac, Thoracic and Vascular Sciences - University of Padua, Padua, Italy.
Gino
G
Gerosa
Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
Mauro
M
Rinaldi
Division of Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
Fiorenzo
F
Gaita
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D009026:Mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome