End-stage renal disease, calcification patterns and clinical outcomes after TAVI,Clinical Research in Cardiology

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End-stage renal disease, calcification patterns and clinical outcomes after TAVI
Clinical Research in Cardiology ( IF 5 ) Pub Date : 2021-11-13 , DOI: 10.1007/s00392-021-01968-y
David Grundmann ₁ , Matthias Linder ₁ , Alina Goßling ₁ , Lisa Voigtländer _{1,

2} , Sebastian Ludwig ₁ , Lara Waldschmidt ₁ , Till Demal ₃ , Oliver D Bhadra ₃ , Andreas Schäfer ₃ , Johannes Schirmer ₃ , Hermann Reichenspurner ₃ , Stefan Blankenberg _{1,

2} , Dirk Westermann _{1,

2} , Niklas Schofer ₁ , Lenard Conradi ₃ , Moritz Seiffert _{1,

2}

Affiliation

Background

Patients with chronic hemodialysis due to end-stage renal disease (ESRD) or severely impaired kidney function (CKD) constitute a relevant share of patients undergoing trans-catheter aortic valve implantation (TAVI). However, data on specific challenges and outcomes remain limited.

Aim

We aimed to characterize this patient population, evaluate clinical results and assess the significance of calcification patterns.

Methods

This retrospective single-center analysis evaluated 2,712 TAVI procedures (2012–2019) according to baseline renal function: GFR < 30 ml/min/1.73m² (CKD; n = 210), chronic hemodialysis (ESRD; n = 119) and control (CTRL; n = 2383). Valvular and vascular calcification patterns were assessed from contrast-enhanced multi-detector computed tomography. Outcomes were evaluated in accordance with the VARC-2 definitions.

Results

Operative risk was higher in ESRD and CKD vs. CTRL (STS-score 8.4% and 7.6% vs. 3.9%, p < 0.001) and patients with ESRD had more severe vascular calcifications (49.1% vs. 33.9% and 29.0%, p < 0.01). Immediate procedural results were similar but non-procedure-related major/life-threatening bleeding was higher in ESRD and CKD (5.0% and 5.3% vs. 1.6%, p < 0.01). 3-year survival was impaired in patients with ESRD and CKD (33.3% and 35.3% vs. 65.4%, p < 0.001). Multivariable analysis identified ESRD (HR 1.60), CKD (HR 1.79) and vascular calcifications (HR 1.29) as predictors for 3-year and vascular calcifications (HR 1.51) for 30-day mortality.

Conclusion

Patients with ESRD and CKD constitute a vulnerable patient group with extensive vascular calcifications. Immediate procedural results were largely unaffected by renal impairment, yielding TAVI a particularly valuable treatment option in these high-risk operative patients. Mid-term survival was determined by underlying renal disease, cardiovascular comorbidities, and vascular calcifications as a novel risk marker.

Graphical abstract

中文翻译：

TAVI 后终末期肾病、钙化模式和临床结果

背景

因终末期肾病 (ESRD) 或肾功能严重受损 (CKD) 而进行慢性血液透析的患者占接受经导管主动脉瓣植入术 (TAVI) 患者的相关比例。然而，关于具体挑战和成果的数据仍然有限。

目标

我们旨在描述该患者群体的特征，评估临床结果并评估钙化模式的重要性。

方法

这项回顾性单中心分析根据基线肾功能评估了 2,712 例 TAVI 手术 (2012–2019)：GFR < 30 ml/min/1.73m ²（CKD；n = 210）、慢性血液透析（ESRD；n = 119）和对照（CTRL；n = 2383）。通过对比增强多探测器计算机断层扫描评估瓣膜和血管钙化模式。根据 VARC-2 定义评估结果。

结果

ESRD 和 CKD 患者的手术风险高于 CTRL（STS 评分 8.4% 和 7.6% 对 3.9%，p < 0.001），ESRD 患者的血管钙化更严重（49.1% 对 33.9% 和 29.0%，p < 0.01)。即刻手术结果相似，但非手术相关的大出血/危及生命的出血在 ESRD 和 CKD 中更高（5.0% 和 5.3% 对 1.6%，p < 0.01）。ESRD 和 CKD 患者的 3 年生存率受损（33.3% 和 35.3% 对 65.4%，p < 0.001）。多变量分析确定 ESRD (HR 1.60)、CKD (HR 1.79) 和血管钙化 (HR 1.29) 作为 3 年死亡率和血管钙化 (HR 1.51) 30 天死亡率的预测因子。