INTRODUCTION: Transcatheter aortic valve implantation (TAVI) is nowadays the preferred procedure for patients with symptomatic aortic stenosis (AS) older than 75 years or not suitable for surgery.
On the other hand, acute kidney injury (AKI) is one of the strongest predictors of mortality after TAVI
The purpose of our study has been to evaluate the impact of a no-contrast approach for TAVI in patients with severe renal disfunction.
METHODS: 41 consecutive patients were enrolled from April 2021 to June 2022 in our Center. Mean age was 83 ± 5 yo, 43% were women. Mean glomerular filtration rate 29 ± 4.2 ml/min; The Society of Thoracic Surgeons mortality score (STS Score) was 16.1 ± 4.5. All procedures were performed without use of contrast dye. All patients underwent angio computed tomography (CT) and Coronary angiography with a minimal use of contrast dye at least two months before the procedure. Echo scan was perfomed to evaluate the femoral and carotid arteries anatomy
Outcomes and events were evaluated according to the Valvular Academic Research Consortium 2 criteria (VARC-2). Baseline and postopertative creatinine were collected for each patient and glomerular filtration rate was calculated using CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. Acute kidney injury was defined using KDIGO definitions as an increase in serum creatinine (Scr) by ≥ 0.3 mg/dl (26.5 mol/l) within 48 hours; or increase in SCr to ≥ 1.5 times base-line or urine volume < 0.5 ml/kg/h for 6 hours.
TAVI procedure was performed under general anesthesia. Intraprocedural transesophageal echocardiogram was used for annulus valve sizing and to monitor proper positioning of self-expanding bioprosthesis.
RESULTS: No patients died during hospital stay. A permanent pacemaker before discharge was required in 2 cases. No patients developed acute kidney injury at 48 h or at discharge.
At 3 and 6 months of follow up, two patients died, one for cerebral event and one for sudden death; mean glomerular filtration rate and creatinine values were similar to pre-discharge values.
CONCLUSIONS: Our data show that a zero-contrast TAVI approach in patients with advanced chronic kidney disease is feasible and should always be considered for these subset of patients