Transcatheter Aortic Valve Replacement with Minimal Contrast Dye in Patients with Renal Insufficiency

Low Contrast Strategies in TAVR: Feasibility and Outcomes to Prevent Renal Injury in Chronic Kidney Disease

BACKGROUND

Contrast volume is a major risk factor for acute kidney injury (AKI) in patients with chronic kidney disease (CKD) after TAVR. Use of a low-contrast (LC) protocol in TAVR may reduce AKI without impacting other clinical outcomes.

METHODS

TAVR patients with Stage 3b or worse CKD between 2015 and 2020 were grouped into LC and normal-contrast (NC). LC was defined as TAVR procedure contrast use (mL) less than estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). The primary outcome was AKI, defined as creatinine elevation > 200% or ≥ 0.3 mg/dL from baseline. Secondary outcomes were 30-day mortality, length of stay, paravalvular leak at 30 days, new dialysis requirement, major vascular complication, re-admission, bleeding, and a composite primary endpoint of secondary outcomes. We performed a propensity-matched analysis, compared cohort outcomes, and stratified outcomes by AKI severity.

RESULTS

Four hundred thirty-seven patients were analyzed. The LC group (n = 173) were more commonly male and had a lower baseline eGFR (31 vs. 33, p = 0.03) than the NC group (n = 264). After propensity-matching, AKI occurred less frequently in LC patients than in the NC patients (17.9 vs. 28.3%, p = 0.0217). There were no inter-group differences in mortality, new dialysis requirement, major vascular complications, bleeding, or re-admissions.

CONCLUSIONS

In TAVR patients with CKD, LC volume was associated with reduced risk of AKI, supporting a LC approach for TAVR in CKD patients.

AIMS

We sought to evaluate the outcomes of a LC versus normal-contrast dose strategy in TAVR amongst patients with CKD.

Renal outcomes in valve-in-valve transcatheter versus redo surgical aortic valve replacement: A systematic review and meta-analysis

INTRODUCTION

Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve-in-valve aortic valve replacement (ViV-TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population undergoing either redo SAVR or ViV-TAVR remains controversial.

METHODS

A systematic database search with meta-analysis was conducted of comparative original articles of ViV-TAVR versus redo SAVR in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to September 2021. Primary outcomes were AKI and RRT. Secondary outcomes were stroke, major bleeding, pacemaker implantation rate, operative mortality, and 30-day mortality.

RESULTS

Our search yielded 5435 relevant studies. Eighteen studies met the inclusion criteria with a total of 11,198 patients. We found ViV-TAVR to be associated with lower rates of AKI, postoperative RRT, major bleeding, pacemaker implantation, operative mortality, and 30-day mortality. No significant difference was observed in terms of stroke rate. The mean incidence of AKI in ViV-TAVR was 6.95% (±6%) and in redo SAVR was 15.2% (±9.6%). For RRT, our data showed that VIV-TAVR to be 1.48% (±1.46%) and redo SAVR to be 8.54% (±8.06%).

CONCLUSION

Renoprotective strategies should be put into place to prevent and reduce AKI incidence regardless of the treatment modality. Patients undergoing re-intervention for the aortic valve constitute a high-risk and frail population in which ViV-TAVR demonstrated it might be a feasible option for carefully selected patients. Long-term follow-up data and randomized control trials will be needed to evaluate mortality and morbidity outcomes between these 2 treatments.