Renal function as predictor of mortality in patients after percutaneous transcatheter aortic valve implantation.
Jan-Malte Sinning,Alexander Ghanem,Hannah Steinhäuser,Viktoria Adenauer,Christoph Hammerstingl,Georg Nickenig,Nikos Werner +6 more
TLDR
Impaired renal function at baseline and the occurrence of periprocedural AKI, independent whether renal function returns to baseline or not, are strong predictors of 30-day and 1-year mortality after TAVI.Abstract:
Objectives The aim of this study was to determine the influence of baseline renal function and periprocedural acute kidney injury (AKI) on prognosis after transcatheter aortic valve implantation (TAVI). Background Evidence is growing that renal function is a major predictor of mortality in patients after TAVI. Methods TAVI was performed with the 18-F CoreValve prosthesis via transfemoral access. All-cause mortality was determined 30 days and 1 year after TAVI in 77 patients with a mean Society of Thoracic Surgeons mortality score of 9.3 ± 6.1% and a mean logistic European System for Cardiac Operative Risk Evaluation of 31.2 ± 17.6%. Results Overall procedural success rate was 98% with 1 periprocedural death. The 30-day mortality was 10%, and 1-year mortality was 26%. The mortality risk increased stepwise across quartiles of baseline serum creatinine. An AKI occurred in 20 of 77 patients: 12 patients (60%) with AKI died during follow-up. The incidence of AKI was related to peripheral arterial disease (65% vs. 39%; p = 0.04), the occurrence of a systemic inflammatory response syndrome (60% vs. 21%, p = 0.002), and post-procedural peri-prosthetic regurgitation ≥2+ (35% vs. 9%, p = 0.02). Impaired renal function at baseline reflected by serum creatinine ≥1.58 mg/dl (hazard ratio: 3.9, 95% confidence interval: 1.6 to 9.5; p = 0.002) and the occurrence of AKI (hazard ratio: 5.9, 95% confidence interval: 2.4 to 14.5, p Conclusions Impaired renal function at baseline and the occurrence of periprocedural AKI, independent whether renal function returns to baseline or not, are strong predictors of 30-day and 1-year mortality after TAVI.read more
Citations
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Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury
Ravindra L. Mehta,John A. Kellum,Sudhir V. Shah,Bruce A. Molitoris,Claudio Ronco,David G. Warnock,Adeera Levin +6 more
TL;DR: An initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI is described.
Journal ArticleDOI
Transcatheter aortic valve implantation: current and future approaches
TL;DR: Improvements in transcatheter valve technology, optimization of procedural and midterm results, and confirmation of long-term durability of transCatheter valve prostheses will determine the expansion of TAVI towards the treatment of a broader spectrum of patients.
Journal ArticleDOI
Evaluation of Multidimensional Geriatric Assessment as a Predictor of Mortality and Cardiovascular Events After Transcatheter Aortic Valve Implantation
Stefan Stortecky,Andreas W. Schoenenberger,André Moser,Bindu Kalesan,Peter Jüni,Thierry Carrel,Seraina Bischoff,Christa-Maria Schoenenberger,Andreas E. Stuck,Stephan Windecker,Peter Wenaweser +10 more
TL;DR: Evidence is provided that risk prediction can be improved by adding MGA-based information to global risk scores and that larger studies are needed for the development and validation of improved risk prediction models.
Journal ArticleDOI
Long-term outcomes after transcatheter aortic valve implantation : insights on prognostic factors and valve durability from the Canadian multicenter experience
Josep Rodés-Cabau,John G. Webb,Anson Cheung,Jian Ye,Eric Dumont,Mark Osten,Christopher M. Feindel,Madhu K. Natarajan,James L. Velianou,Giussepe Martucci,Benoit DeVarennes,Robert J. Chisholm,Mark D. Peterson,Christopher R. Thompson,David A. Wood,Stefan Toggweiler,Ronen Gurvitch,Samuel V. Lichtenstein,Daniel Doyle,Robert DeLarochellière,Kevin Teoh,Victor Chu,Kevin R. Bainey,Kevin Lachapelle,Asim N. Cheema,David A. Latter,Jean G. Dumesnil,Philippe Pibarot,Eric Horlick +28 more
TL;DR: Almost one-half of the patients who underwent TAVI because of a high or prohibitive surgical risk profile had died at a mean follow-up of 3.5 years, with special focus on the causes and predictors of late mortality and valve durability.
Journal ArticleDOI
Evaluation and Management of Paravalvular Aortic Regurgitation After Transcatheter Aortic Valve Replacement
Jan-Malte Sinning,Mariuca Vasa-Nicotera,Derek Chin,Christoph Hammerstingl,Alexander Ghanem,Johan Bence,Jan Kovac,Eberhard Grube,Georg Nickenig,Nikos Werner +9 more
TL;DR: A multimodal approach for the evaluation of PAR with the use of hemodynamic measurements and imaging modalities is imperative to precisely quantify the severity of aortic regurgitation immediately after valve implantation and to identify patients who will benefit from corrective measures such as post-dilation or valve-in-valve implantation.
References
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Roger C. Bone,Robert A. Balk,F. B. Cerra,R. P. Dellinger,A. M. Fein,William A. Knaus,Roland M. H. Schein,W. J. Sibbald +7 more
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Acute Kidney Injury Network: Report of an Initiative to Improve Outcomes in Acute Kidney Injury
Ravindra L. Mehta,John A. Kellum,Sudhir V. Shah,Bruce A. Molitoris,Claudio Ronco,David G. Warnock,Adeera Levin +6 more
TL;DR: The Acute Kidney Injury Network (AKI Network) as discussed by the authors is a multidisciplinary collaborative network focused on AKI, which was established to improve care for patients with or at risk for AKI.
Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury
Ravindra L. Mehta,John A. Kellum,Sudhir V. Shah,Bruce A. Molitoris,Claudio Ronco,David G. Warnock,Adeera Levin +6 more
TL;DR: An initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI is described.
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Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee: American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis
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Bernard Iung,Gabriel Baron,Eric G. Butchart,François Delahaye,Christa Gohlke-Bärwolf,Olaf W. Levang,Pilar Tornos,Jean-Louis Vanoverschelde,Frank Vermeer,Eric Boersma,Philippe Ravaud,Alec Vahanian +11 more
TL;DR: Degenerative aetiologies were the most frequent in aortic VHD and mitral regurgitation while most cases of mitral stenosis were of rheumatic origin.
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