Potential of Transcatheter Aortic Valve Replacement to Improve Post-Procedure Renal Function

• Published in: Cardiovascular revascularization medicine 2017-10, Vol.18 (7), p.507-511
• Main Authors: Faillace, Bruno L.R, Ribeiro, Henrique B, Campos, Carlos M, Truffa, Adriano A.M, Bernardi, Fernando L, Oliveira, Marcos D.P, Mariani, José, Marchini, Julio F, Tarasoutchi, Flavio, Lemos, Pedro A
• Format: Article
• Language: English
• Subjects: Acute kidney injury; Acute Kidney Injury - diagnosis; Acute Kidney Injury - epidemiology; Acute Kidney Injury - physiopathology; Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Biomarkers - blood; Brazil - epidemiology; Cardiovascular; Comorbidity; Creatinine - blood; Female; Glomerular Filtration Rate; Hemodynamics; Humans; Kidney - physiopathology; Kidney Diseases - diagnosis; Kidney Diseases - epidemiology; Kidney Diseases - physiopathology; Male; Recovery of Function; Registries; Renal failure; Renal improvement; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors; Transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2017.03.031

Abstract Background Baseline comorbidities including renal dysfunction are frequently found in patients treated with transcatheter aortic valve replacement (TAVR) and may increase the risks of acute kidney injury (AKI), although some of them may actually improve renal function. We aimed to evaluate the potential of TAVR to acutely improve post-procedure renal function. Methods This is a prospective single-center registry of consecutive patients with severe symptomatic aortic stenosis treated by transfemoral TAVR. Creatinine levels were determined at baseline and daily until hospital discharge. AKI was defined according to VARC-2 criteria. Patients who had improvement of creatinine levels >25% were classified as having TAVR induced renal function improvement (TIRFI). Results A total of 69 patients undergoing TAVR were included, with a mean age of 83.0±7.4 years, being 24.6% diabetics, with a median STS score of 9.2 (5.1–21.6). Using the VARC-2 criteria, the majority of patients (64.6%) did not have renal impairment, while AKI was detected in 35.4% of the patients. Importantly, in those with prior severe renal dysfunction (clearance50% in 1 patient (1.5%), and at hospital discharge the majority of the patients (88.6%) left the hospital in their original or better renal function categories. Conclusion Despite multiple comorbidities in a selected TAVR-population and the use of contrast media, TAVR did not impair renal function in a majority of patients, with a significant proportion of them rather having acute renal function improvement.