Non-contrast transcatheter aortic valve implantation for patients with aortic stenosis and chronic kidney disease: a pilot study

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorFREIRE, Antonio Fernando Diniz
dc.contributor.authorNICZ, Pedro Felipe Gomes
dc.contributor.authorRIBEIRO, Henrique Barbosa
dc.contributor.authorFILIPPINI, Filippe Barcellos
dc.contributor.authorACCORSI, Tarso Duenas
dc.contributor.authorLIBERATO, Gabriela
dc.contributor.authorNOMURA, Cesar Higa
dc.contributor.authorCASSAR, Renata de Sa
dc.contributor.authorVIEIRA, Marcelo Luiz Campos
dc.contributor.authorJR, Wilson Mathias
dc.contributor.authorPOMERANTZEFF, Pablo Maria Alberto
dc.contributor.authorTARASOUTCHI, Flavio
dc.contributor.authorABIZAID, Alexandre
dc.contributor.authorFILHO, Roberto Kalil
dc.contributor.authorJR, Fabio Sandoli de Brito
dc.date.accessioned2023-08-16T17:46:14Z
dc.date.available2023-08-16T17:46:14Z
dc.date.issued2023
dc.description.abstractBackgroundAcute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI). Of note, it is associated with a threefold increase in all-cause and cardiac death. We propose a new non-contrast strategy for evaluating and performing the TAVI procedure that can be especially valuable for patients with aortic stenosis (AS) and chronic kidney disease (CKD) to prevent AKI. MethodsPatients with severe symptomatic AS and CKD stage & GE;3a were evaluated for TAVI using four non-contrast imaging modalities for procedural planning: transesophageal echocardiogram (TEE), cardiac magnetic resonance, multidetector computed tomography (MDCT), and aortoiliac CO2 angiography. Patients underwent transfemoral (TF) TAVI using the self-expandable Evolut R/Pro, and the procedures were guided by fluoroscopy and TEE. Contrast MDCT and contrast injection at certain checkpoints during the procedure were used in a blinded fashion to guarantee patient safety. ResultsA total of 25 patients underwent TF-TAVI with the zero-contrast technique. The mean age was 79.9 & PLUSMN; 6.1 years, 72% in NYHA class III/IV, with a mean STS-PROM of 3.0% & PLUSMN; 1.5%, and creatinine clearance of 49 & PLUSMN; 7 ml/min. The self-expandable Evolut R and Pro were implanted in 80% and 20% of patients, respectively. In 36% of the cases, the transcatheter heart valve (THV) chosen was one size larger than the one by contrast MDCT, but none of these cases presented adverse events. Device success and the combined safety endpoint (at 30 days) both achieved 92%. Pacemaker implantation was needed in 17%. ConclusionThis pilot study demonstrated that the zero-contrast technique for procedural planning and THV implantation was feasible and safe and might become the preferable strategy for a significant population of CKD patients undergoing TAVR. Future studies with a larger number of patients are still needed to confirm such interesting findings.eng
dc.description.indexPubMed
dc.description.indexWoS
dc.description.indexScopus
dc.description.sponsorshipMedtronic
dc.identifier.citationFRONTIERS IN CARDIOVASCULAR MEDICINE, v.10, article ID 1175600, 8p, 2023
dc.identifier.doi10.3389/fcvm.2023.1175600
dc.identifier.issn2297-055X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/54631
dc.language.isoeng
dc.publisherFRONTIERS MEDIA SAeng
dc.relation.ispartofFrontiers in Cardiovascular Medicine
dc.rightsopenAccesseng
dc.rights.holderCopyright FRONTIERS MEDIA SAeng
dc.subjecttranscatheter aortic valve replacementeng
dc.subjectaortic stenosiseng
dc.subjectrenal failureeng
dc.subjectzero contrasteng
dc.subjectrenal insufficiencyeng
dc.subject.otheroutcomeseng
dc.subject.otherinjuryeng
dc.subject.otherreplacementeng
dc.subject.otherpredictorseng
dc.subject.otherimpacteng
dc.subject.wosCardiac & Cardiovascular Systemseng
dc.titleNon-contrast transcatheter aortic valve implantation for patients with aortic stenosis and chronic kidney disease: a pilot studyeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.citation.scopus2
hcfmusp.contributor.author-fmusphcANTONIO FERNANDO DINIZ FREIRE
hcfmusp.contributor.author-fmusphcPEDRO FELIPE GOMES NICZ
hcfmusp.contributor.author-fmusphcHENRIQUE BARBOSA RIBEIRO
hcfmusp.contributor.author-fmusphcFILIPPE BARCELLOS FILIPPINI
hcfmusp.contributor.author-fmusphcTARSO AUGUSTO DUENHAS ACCORSI
hcfmusp.contributor.author-fmusphcGABRIELA LIBERATO
hcfmusp.contributor.author-fmusphcCESAR HIGA NOMURA
hcfmusp.contributor.author-fmusphcRENATA DE SA CASSAR
hcfmusp.contributor.author-fmusphcMARCELO LUIZ CAMPOS VIEIRA
hcfmusp.contributor.author-fmusphcWILSON MATHIAS JUNIOR
hcfmusp.contributor.author-fmusphcPABLO MARIA ALBERTO POMERANTZEFF
hcfmusp.contributor.author-fmusphcFLAVIO TARASOUTCHI
hcfmusp.contributor.author-fmusphcALEXANDRE ANTONIO CUNHA ABIZAID
hcfmusp.contributor.author-fmusphcROBERTO KALIL FILHO
hcfmusp.contributor.author-fmusphcFABIO SANDOLI DE BRITO JUNIOR
hcfmusp.description.articlenumber1175600
hcfmusp.description.volume10
hcfmusp.origemWOS
hcfmusp.origem.pubmed37388643
hcfmusp.origem.scopus2-s2.0-85163983958
hcfmusp.origem.wosWOS:001018262800001
hcfmusp.publisher.cityLAUSANNEeng
hcfmusp.publisher.countrySWITZERLANDeng
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hcfmusp.scopus.lastupdate2024-04-12
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