Long-term outcomes after transcatheter aortic valve replacement with minimal contrast in chronic kidney disease.
Long-term outcomes after transcatheter aortic valve replacement with minimal contrast in chronic kidney disease.
复制标题
经导管主动脉瓣置换术后的长期结果与慢性肾病的对比最小。
DOI：
10.1002/ccd.29378
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
Rzucidlo,Justyna;Jaspan,Vita;Paone,Darien;Jilaihawi,Hasan;Xia,Yuhe;Kapitman,Anna;Nakashima,Makoto;He,Yuxin;Ibrahim,Homam;Pushkar,Illya;Neuburger,PeterJ;Saric,Muhamed;Bamira,Daniel;Paschke,Sonja;Kalish,Chloe;Staniloae,Cezar;
肾功能不全患者经导管主动脉瓣置换术（TAVR）后短期结局较差。方法回顾性病历审查确定了2014年9月至2017年1月期间接受TAVR的575例连续非血液透析患者。结局由VARC-2标准定义。在中位随访811天（四分位距125- 1，151）时评估了全因死亡率的主要结局。结果术前肾小球滤过率（GFR）≥60 ml/min的患者占51.7%，30-60 ml/min的患者占42.1%，< 30 ml/min的患者占6.3%。经股动脉入路的使用率（98.8%）和器械成功率（91.0%）在各组之间没有差异，但在GFR较低的情况下使用的造影剂较少（23 ml [15-33]，24 ml [14-33]，13 ml [8-20];p< .001）。GFR越低，围手术期卒中（0.7%、2.1%、11.1%;p< .001）越高。核心实验室对发生术中卒中的患者的术前计算机断层扫描进行分析，发现GFR 30-60 ml/min的4例患者中有3例患者存在卒中的潜在解剖基质，所有3例患者GFR <30 ml/min（严重动脉粥样硬化是存在的最常见解剖基质亚型）。与GFR ≥60 ml/min相比，GFR 30-60 ml/min（HR 1.61 [1.00-2.59]; aHR 1.61 [0.91-2.83]）和GFR <30 ml/min（HR 2.41 [1.06-5.48]; aHR 2.34 [0.90-6.09]）的全因死亡率较高，但经多变量调整后不显著。随访超声心动图数据，在63%，表现出结构性心脏瓣膜恶化随着时间的推移groups.ConclusionsPatients之间没有差异，基线肾功能不全仍然是一个具有挑战性的人口与长期的结果不佳，尽管程序优化与transfemoral-第一和极低对比度的方法。
BackgroundPatients with renal insufficiency have poor short‐term outcomes after transcatheter aortic valve replacement (TAVR).MethodsRetrospective chart review identified 575 consecutive patients not on hemodialysis who underwent TAVR between September 2014 and January 2017. Outcomes were defined by VARC‐2 criteria. Primary outcome of all‐cause mortality was evaluated at a median follow‐up of 811 days (interquartile range 125–1,151).ResultsPreprocedural glomerular filtration rate (GFR) was ≥60 ml/min in 51.7%, 30–60 ml/min in 42.1%, and < 30 ml/min in 6.3%. Use of transfemoral access (98.8%) and achieved device success (91.0%) did not differ among groups, but less contrast was used with lower GFR (23 ml [15–33], 24 ml [14–33], 13 ml [8–20];p< .001). Peri‐procedural stroke (0.7%, 2.1%, 11.1%;p< .001) was higher with lower GFR. Core lab analysis of preprocedural computed tomography scans of patients who developed a peri‐procedural stroke identified potential anatomic substrate for stroke in three out of four patients with GFR 30–60 ml/min and all three with GFR <30 ml/min (severe atheroma was the most common subtype of anatomical substrate present). Compared to GFR ≥60 ml/min, all‐cause mortality was higher with GFR 30–60 ml/min (HR 1.61 [1.00–2.59]; aHR 1.61 [0.91–2.83]) and GFR <30 ml/min (HR 2.41 [1.06–5.48]; aHR 2.34 [0.90–6.09]) but not significant after multivariable adjustment. Follow‐up echocardiographic data, available in 63%, demonstrated no difference in structural heart valve deterioration over time among groups.ConclusionsPatients with baseline renal insufficiency remain a challenging population with poor long‐term outcomes despite procedural optimization with a transfemoral‐first and an extremely low‐contrast approach.