Impact of Renal Dysfunction on Results of Transcatheter Aortic Valve Replacement Outcomes in a Large Multicenter Cohort

Pablo Codner, Amos Levi, Giuseppe Gargiulo, Fabien Praz, Kentaro Hayashida, Yusuke Watanabe, Darren Mylotte, Nicolas Debry, Marco Barbanti, Thierry Lefèvre, Thomas Modine, Johan Bosmans, Stephan Windecker, Israel Barbash, Jan Malte Sinning, Georg Nickenig, Alon Barsheshet, Ran Kornowski

Research output: Contribution to journalArticle

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Abstract

Patients with advanced chronic renal dysfunction were excluded from randomized trials of transcatheter aortic valve replacement (TAVR). The potential impact of chronic renal disease on TAVR prognosis is not fully understood. We aim to evaluate outcomes within a large cohort of patients who underwent TAVR distinguished by renal function. Baseline characteristics, procedural data, and clinical follow-up findings were collected from 10 high-volume TAVR centers in Europe, Israel, and Japan. Data were analyzed according to renal function. Patients (n = 1,204) were divided into 4 groups according to pre-TAVR-estimated glomerular filtration rate (eGFR): group I (eGFR >60), n = 288 (female 45%), group II (eGFR 31 to 60), n = 452 (female 61%), group III (eGFR ≤30), n = 398 (female 61%), and group IV (dialysis), n = 66 (female 31%). Mean Society of Thoracic Surgeons score was higher in patients with lower preprocedural eGFR. All-cause mortality at 1 year was higher in patients with lower eGFR (9.0%, 12.1%, 24.3%, and 24.2% for group I, II, III, and IV, respectively, p <0.001). Multivariate analysis demonstrated that eGFR ≤30, but not eGFR 31 to 60, was associated with increased risk of death (odds ratio 3), bleeding (odds ratio 5.2), and device implantation failure (hazard ratio 2.28). For each 10 ml/min decrease in eGFR, there was an associated relative increase in the risk of death (35%; p <0.001), cardiovascular death (14%; p = 0.018), major bleeding 35% (p <0.001), and transcatheter valve failure (16%; p = 0.007). Renal dysfunction was not associated with stroke or need for pacemaker implantation. In conclusion, among patients who underwent TAVR, baseline renal dysfunction is an important independent predictor of morbidity and mortality.

Original languageEnglish
Pages (from-to)1888-1896
Number of pages9
JournalAmerican Journal of Cardiology
Volume118
Issue number12
DOIs
Publication statusPublished - 2016 Dec 15

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Glomerular Filtration Rate
Kidney
Odds Ratio
Equipment Failure
Hemorrhage
Transcatheter Aortic Valve Replacement
Mortality
Israel
Chronic Renal Insufficiency
Dialysis
Japan
Multivariate Analysis
Stroke
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Renal Dysfunction on Results of Transcatheter Aortic Valve Replacement Outcomes in a Large Multicenter Cohort. / Codner, Pablo; Levi, Amos; Gargiulo, Giuseppe; Praz, Fabien; Hayashida, Kentaro; Watanabe, Yusuke; Mylotte, Darren; Debry, Nicolas; Barbanti, Marco; Lefèvre, Thierry; Modine, Thomas; Bosmans, Johan; Windecker, Stephan; Barbash, Israel; Sinning, Jan Malte; Nickenig, Georg; Barsheshet, Alon; Kornowski, Ran.

In: American Journal of Cardiology, Vol. 118, No. 12, 15.12.2016, p. 1888-1896.

Research output: Contribution to journalArticle

Codner, P, Levi, A, Gargiulo, G, Praz, F, Hayashida, K, Watanabe, Y, Mylotte, D, Debry, N, Barbanti, M, Lefèvre, T, Modine, T, Bosmans, J, Windecker, S, Barbash, I, Sinning, JM, Nickenig, G, Barsheshet, A & Kornowski, R 2016, 'Impact of Renal Dysfunction on Results of Transcatheter Aortic Valve Replacement Outcomes in a Large Multicenter Cohort', American Journal of Cardiology, vol. 118, no. 12, pp. 1888-1896. https://doi.org/10.1016/j.amjcard.2016.08.082
Codner, Pablo ; Levi, Amos ; Gargiulo, Giuseppe ; Praz, Fabien ; Hayashida, Kentaro ; Watanabe, Yusuke ; Mylotte, Darren ; Debry, Nicolas ; Barbanti, Marco ; Lefèvre, Thierry ; Modine, Thomas ; Bosmans, Johan ; Windecker, Stephan ; Barbash, Israel ; Sinning, Jan Malte ; Nickenig, Georg ; Barsheshet, Alon ; Kornowski, Ran. / Impact of Renal Dysfunction on Results of Transcatheter Aortic Valve Replacement Outcomes in a Large Multicenter Cohort. In: American Journal of Cardiology. 2016 ; Vol. 118, No. 12. pp. 1888-1896.
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abstract = "Patients with advanced chronic renal dysfunction were excluded from randomized trials of transcatheter aortic valve replacement (TAVR). The potential impact of chronic renal disease on TAVR prognosis is not fully understood. We aim to evaluate outcomes within a large cohort of patients who underwent TAVR distinguished by renal function. Baseline characteristics, procedural data, and clinical follow-up findings were collected from 10 high-volume TAVR centers in Europe, Israel, and Japan. Data were analyzed according to renal function. Patients (n = 1,204) were divided into 4 groups according to pre-TAVR-estimated glomerular filtration rate (eGFR): group I (eGFR >60), n = 288 (female 45{\%}), group II (eGFR 31 to 60), n = 452 (female 61{\%}), group III (eGFR ≤30), n = 398 (female 61{\%}), and group IV (dialysis), n = 66 (female 31{\%}). Mean Society of Thoracic Surgeons score was higher in patients with lower preprocedural eGFR. All-cause mortality at 1 year was higher in patients with lower eGFR (9.0{\%}, 12.1{\%}, 24.3{\%}, and 24.2{\%} for group I, II, III, and IV, respectively, p <0.001). Multivariate analysis demonstrated that eGFR ≤30, but not eGFR 31 to 60, was associated with increased risk of death (odds ratio 3), bleeding (odds ratio 5.2), and device implantation failure (hazard ratio 2.28). For each 10 ml/min decrease in eGFR, there was an associated relative increase in the risk of death (35{\%}; p <0.001), cardiovascular death (14{\%}; p = 0.018), major bleeding 35{\%} (p <0.001), and transcatheter valve failure (16{\%}; p = 0.007). Renal dysfunction was not associated with stroke or need for pacemaker implantation. In conclusion, among patients who underwent TAVR, baseline renal dysfunction is an important independent predictor of morbidity and mortality.",
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