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Impact of Pre-existing Kidney Dysfunction on Outcomes Following Transcatheter Aortic Valve Replacement

[ Vol. 13 , Issue. 4 ]

Author(s):

Ikechukwu A. Ifedili, Oluwaseyi Bolorunduro, Tamunoinemi Bob-Manuel, Mark R. Heckle, Ellis Christian, Saibal Kar and Uzoma N. Ibebuogu*   Pages 283 - 292 ( 10 )

Abstract:


Background: Pre-existing chronic kidney disease (CKD) portends adverse outcomes following heart valve surgery. However, only limited and conflicting evidence is available on the impact of CKD on outcomes following transcatheter aortic valve replacement (TAVR). The objective of this review was to evaluate the effect of pre-existing CKD on TAVR outcomes.

Methods: We performed a systematic electronic search using the PRISMA statement to identify all randomized controlled trials and observational studies investigating the effect of pre-existing CKD on outcomes following TAVR. 30-day and long-term outcomes were measured comparing patients with Glomerular filtration rate (GFR) ≥60 to those with GFR <60.

Results: Ten studies were analyzed comprising of 8688 patients. Compared to patients with GFR ≥60, those with GFR < 60 had worse 30-day all cause mortality (OR 1.40, 95% CI: 1.13-1.73), cardiovascular mortality (OR 1.66, 95% CI: 1.04-2.67), strokes (OR 1.39, 95% CI: 1.05-1.85), acute kidney injury (OR 1.42, 95% CI: 1.21-1.66) and the risk for dialysis (OR 2.13, 95% CI: 1.07-4.22). There was no difference in device success (p=0.873), major or life threatening bleeds (p = 0.302), major vascular complications (p=0.525), need for pacemaker implantation (p = 0.393) or paravalvular leaks (p = 0.630). All-cause mortality at 1 year was also significantly higher in patients with GFR <60 (OR 1.80, 95% CI: 1.26-2.56).

Conclusion: Pre-existing CKD defined as GFR <60 is a strong predictor of worse short and longterm outcomes following TAVR. Active measures should be taken to mitigate the postprocedure risk in these group of patients.

Keywords:

Aortic stenosis, transcatheter aortic valve replacement, chronic kidney disease, replacement, PRISMA, glomerular filtration.

Affiliation:

Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Mempis, Tennessee, Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Mempis, Tennessee, Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Mempis, Tennessee, Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Mempis, Tennessee, Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Mempis, Tennessee, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, 956 Court Avenue, Suite D 334, Memphis, Tennessee 38163, TN

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