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Impact of transcatheter aortic valve implantation on kidney function in patients with severe aortic stenosis
Session:
Sessão de Posters 53 - Complicações de TAVI
Speaker:
Ana Isabel Pinho
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Isabel Pinho; Catarina Amaral Marques; Luís Daniel Santos; Cátia Oliveira; André Cabrita; Teresa Pinho; Francisca Saraiva; Isabel Miranda; Adelino Leite Moreira; Marta Tavares Silva; Carla Sousa; Rui André Rodrigues
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt">Background: Aortic valve stenosis may diminish renal perfusion and promote congestion, thereby worsening kidney function (KF). Transcatheter aortic valve implantation (TAVI) is expected to interrupt this cycle and improve cardio-renal function. This study aimed to clarify the effect of TAVI on KF in the acute and chronic phases.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt">Methods: We conducted a prospective observational study that included patients (pts) undergoing transfemoral TAVI at a Portuguese hospital between November 2021 and May 2023. Exclusion criteria included unwillingness to provide written consent, chronic kidney disease (CKD) with a Glomerular Filtration Rate (eGFR) <25 ml/min/1.73 m², atrial fibrillation, non-revascularized ischemic heart disease, active autoimmune or neoplastic disease. Serum creatinine (sCr) levels were collected on the day before TAVI (baseline sCr), 48 hours after TAVI and at 6 months follow-up.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt">Results: Forty-seven pts (mean age 82±5, 64% female) with a complete 6-month follow-up were included. Baseline sCr was 1.00±0.36 mg/dL and pre-TAVI eGFR was 55±20 ml/min/1.73 m²; 43% of the pts had CKD with an eGFR 25-59 ml/min/1.73 m². </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt">Compared to baseline levels, mean sCr marginally decreased without statistical significance (0.95±0.50 vs 1.00±0.36, mean difference -0.06±0.33 mg/dL, p=0.25) and eGFR significantly improved (68±23 vs 55±20, mean difference +6±13 ml/min/1.73m², p=0.003) on the second day after TAVI. At 6 months follow-up, both sCr (1.09±0.39 vs 1.00±0.36, mean difference +0.09±0.26 mg/dL, p=0.02) and eGFR (57±19 vs 62±20, mean difference -5±13 ml/min/1.73m², p=0.01) deteriorated compared to baseline levels. Brain natriuretic peptide levels improved at 6 months (277±250 vs 132±135 pg/mL, p<0.001). </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt">Pts were divided in 2 groups according to baseline eGFR: no relevant CKD (baseline eGFR ≥ 60 ml/min/1.73 m²) and CKD. Both groups displayed acute improvement in KF but the group with no CKD presented a decline in baseline KF at follow-up compared with CKD (difference in sCr to baseline levels: +0.16±0.19 vs -0.01±0.31mg/dL, p=0.006; difference in eGFR to baseline levels: -10±12 vs +2±12 ml/min/1.73m², p=0.03) [figure 1]. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt">At follow-up, 28% of the patients had worsened KF, defined as ≥20% decrease in baseline eGFR; significant deterioration of KF occurred more often in pts with no previous CKD (37% vs 15%, p=0.02). </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt">Conclusions: Our study suggests that cardiorenal syndrome is partially responsible for CKD in pts in need of TAVI and that there is potential for improvement in both renal and cardiac function after this procedure. Pts with previous CKD showed improvement in eGFR immediately after TAVI and stable KF at follow-up. Interestingly, patients with no previous relevant CKD showed higher rates of significant renal deterioration at 6 months. The fact that some pts sustained significant KF impairment warrants more studies for identification of pts at risk and potential preventive measures. </span></span></span></p>
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