Transcatheter Aortic Valve Replacement with Minimal Contrast Dye in Patients with Renal Insufficiency

Yonsei Medical Journal 2021년 62권 11호 p.990 ~ p.996

최자연(Choi Jah-Yeon) - Korea University College of Medicine Korea University Guro Hospital Cardiovascular Center
홍그루(Hong Geu-Ru) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
홍성진(Hong Sung-Jin) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
심지영(Shim Chi-Young) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
안철민(Ahn Chul-Min) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
김중선(Kim Jung-Sun) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
김병극(Kim Byeong-Keuk) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
고영국(Ko Young-Guk) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
최동훈(Choi Dong-Hoon) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
장양수(Jang Yang-Soo) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
홍명기(Hong Myeong-Ki) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology

Abstract

Purpose: Concerns have been consistently raised in regards to the considerable amount of contrast dye used during transcatheter aortic valve replacement (TAVR) in patients with renal insufficiency. In the present study, we introduced minimal contrast TAVR and compared its 30-day clinical outcomes with conventional TAVR.

Materials and Methods: We retrospectively investigated 369 patients who underwent TAVR between July 2011 and April 2020 in our institute. Among them, 93 patients with severe aortic stenosis and renal insufficiency (estimated glomerular filtration rate ≤50 mL/min/1.73 m2) were included and divided into a conventional TAVR group (n=56) and a minimal contrast TAVR group (n=37). In the minimal contrast TAVR group, the total amount of contrast was <10 mL during the entire TAVR procedure. Thirty-day major adverse clinical events (MACE), including death, stroke, implantation of permanent pacemaker, and initiation of hemodialysis, were investigated.

Results: The incidence of MACE was significantly lower in the minimal contrast TAVR group than the conventional TAVR group (16.2% vs. 42.9%, p=0.010). Death occurred in 9 patients (16.1%) in the conventional TAVR group and in 0 patients in the minimal contrast group (p=0.011). Hemodialysis was initiated in 2 patients (5.4%) in the minimal contrast TAVR group and in 7 patients (12.5%) in the conventional TAVR group (p=0.256). Multivariate regression analysis showed that the minimal contrast TAVR procedure was an independent predictor for reducing MACE (hazard ratio 0.208, 95% confidence interval: 0.080?0.541, p=0.001).

Conclusion: Minimal contrast TAVR is feasible and shows more favorable short-term clinical outcomes than conventional TAVR in patients with renal insufficiency.

키워드

Aortic stenosis, renal insufficiency, transcatheter aortic valve replacement
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SCI(E) MEDLINE 학술진흥재단(KCI) KoreaMed 
주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
The incidence of MACE was significantly lower in the minimal contrast TAVR group than the conventional TAVR group (16.2% vs. 42.9%, p=0.010). Death occurred in 9 patients (16.1%) in the conventional TAVR group and in 0 patients in the minimal contrast group (p=0.011).
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ICD 03
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