Transcatheter Aortic Valve Implantation in Patients With Advanced Chronic Kidney Disease

被引：36

作者：

Conrotto, Federico ^{[1
]}

Salizzoni, Stefano ^{[2
]}

Andreis, Alessandro ^{[1
]}

D'Ascenzo, Fabrizio ^{[1
]}

D'Onofrio, Augusto ^{[3
]}

Agrifoglio, Marco ^{[4
]}

Chieffo, Alaide ^{[5
]}

Colombo, Antonio ^{[5
]}

Rapetto, Filippo ^{[6
]}

Santini, Francesco ^{[6
]}

Tarantini, Giuseppe ^{[3
]}

Gabbieri, Davide ^{[7
]}

Savini, Carlo ^{[8
]}

Imme, Sebastiano ^{[9
]}

Ribichini, Flavio ^{[10
]}

Valsecchi, Orazio ^{[11
]}

Aiello, Marco ^{[12
]}

Lixi, Giovanni ^{[13
]}

Iadanza, Alessandro ^{[14
]}

Pompei, Esmeralda ^{[15
]}

Stolcova, Miroslava ^{[16
]}

Ornaghi, Diego ^{[17
]}

Minati, Alessandro ^{[18
]}

Cassese, Mauro ^{[19
]}

Martinelli, Gian Luca ^{[19
]}

Sbarra, Pierluigi ^{[1
]}

Agostinelli, Andrea ^{[20
]}

Audo, Andrea ^{[21
]}

Pieroni, Andrea ^{[22
]}

Fiorilli, Rosario ^{[23
]}

Gerosa, Gino ^{[3
]}

Rinaldi, Mauro ^{[2
]}

Gaita, Fiorenzo ^{[1
]}

机构：

[1] AOU Citta Salute & Sci Torino, Div Cardiol, Turin, Italy

[2] AOU Citta Salute & Sci Torino, Dept Surg Sci, Turin, Italy

[3] Univ Padua, Dept Cardiac Thorac & Vasc Sci, Padua, Italy

[4] Univ Milan, Dept Clin Sci & Community, Ctr Cardiol Monzino, Milan, Italy

[5] Osped San Raffaele, Milan, Italy

[6] IRCCS San Martino IST, Div Cardiochirurg, Genoa, Italy

[7] Hesperia Hosp, Modena, Italy

[8] AOU Policlin S Orsola Malpighi, Bologna, Italy

[9] Univ Catania, Osped Ferrarotto, Catania, Italy

[10] AOU Integrata Verona, Verona, Italy

[11] AO Papa Giovanni XXIII, Bergamo, Italy

[12] IRCCS Policin S Matteo, Pavia, Italy

[13] AO Brotzu, Cagliari, Italy

[14] AOU Policlin Le Scotte, Siena, Italy

[15] AOUD Santa Maria della Misericordia, Udine, Italy

[16] AOU Careggi, Florence, Italy

[17] Humanitas Res Hosp, Rozzano, Italy

[18] Osped Cattinara, Trieste, Italy

[19] Clin S Maria, Bari, Italy

[20] Osped Maggiore Parma, Parma, Italy

[21] AO Cesare Biagio & Arrigo, Alessandria, Italy

[22] AOU Pisana, Pisa, Italy

[23] Azienda Osped San Camillo Forlanini, Rome, Italy

来源：

AMERICAN JOURNAL OF CARDIOLOGY | 2017年 / 119卷 / 09期

关键词：

MIDTERM OUTCOMES; RENAL-FUNCTION; REPLACEMENT; REGISTRY; SURVIVAL; IMPACT;

D O I：

10.1016/j.amjcard.2017.01.042

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 m(2) stage 4 (S4), <15 ml/min/1.73 m(2) stage 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. (C) 2017 Elsevier Inc. All rights reserved.

引用

页码：1438 / 1442

页数：5

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