Extravalvular Cardiac Damage and Renal Function Following Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

• Published in: Canadian journal of cardiology 2021-06, Vol.37 (6), p.904-912
• Main Authors: Pighi, Michele, Fezzi, Simone, Pesarini, Gabriele, Venturi, Gabriele, Giovannini, Davide, Castaldi, Gianluca, Lunardi, Mattia, Ferrero, Valeria, Scarsini, Roberto, Ribichini, Flavio
• Format: Article
• Language: English
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2020.12.021

In this study we sought to determine the differences in incidence of acute kidney injury (AKI) and acute kidney recovery (AKR) among patients undergoing transcatheter aortic valve implantation (TAVI), according to the degree of extravalvular cardiac damage (EVCD). From the Verona Valvular Heart Disease Registry, 674 symptomatic severe aortic stenosis (AS) patients were selected and retrospectively analysed. Using echocardiographic data, patients were classified based on the degree of EVCD. After dichotomized analysis, patients in EVCD stage 3 or 4 reported a significantly higher rate of AKI (29.5% vs 11.2%; P < 0.001). Using a multivariate analysis model, higher EVCD stage, lower glomerular filtrate rate (GFR) at admission, and amount of contrast used were found to be independent predictors of AKI, whereas stage of cardiac damage and GFR were found to be independent predictors of AKR. For the overall population after multivariate analysis AKI was associated with a higher incidence of 12-month all-cause mortality (hazard ratio, 2.142; 95% confidence interval, 1.082-4.239; P = 0.029) with a significant impact in the advanced cardiac damage stages, but not in the early stages (P for interaction = 0.006). AKR did not reduce adverse clinical outcomes but was associated with improved renal function at 12 months. Increase in EVCD stage was associated with a higher rate of AKI after TAVI. AKI had a negative impact on long-term clinical outcomes but only in patients with advanced cardiac damage. AKR did not reduce adverse clinical outcomes but was associated with improved renal function at 12 months. Nous avons tenté de définir les différences quant à l’incidence des cas d’atteinte rénale aiguë (ARA) et des cas de rétablissement après une atteinte rénale aiguë (R-ARA) chez les patients subissant une implantation valvulaire aortique par cathéter (IVAC), en fonction de l’importance des lésions cardiaques extravalvulaires (LCEV). Nous avons analysé rétrospectivement les cas de 674 patients atteints de sténose de l’aorte (SA) grave et symptomatique figurant dans le registre des cardiopathies valvulaires de Verona (Verona Valvular Heart Disease Registry). Les patients ont été classifiés en fonction de l’importance des LCEV, déterminée à partir des données échocardiographiques. Les résultats de notre analyse dichotomique montrent que les patients présentant des LCEV de stade 3 ou 4 ont été significativement plus nombreux à souffrir d’une ARA (29,5 % vs 11,2 %; p < 0,001)