Transcatheter Aortic Valve Replacement with Minimal Contrast Dye in Patients with Renal Insufficiency
Yonsei Medical Journal 2021³â 62±Ç 11È£ p.990 ~ p.996
ÃÖÀÚ¿¬(Choi Jah-Yeon) - Korea University College of Medicine Korea University Guro Hospital Cardiovascular Center
È«±×·ç(Hong Geu-Ru) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
È«¼ºÁø(Hong Sung-Jin) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
½ÉÁö¿µ(Shim Chi-Young) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
¾Èö¹Î(Ahn Chul-Min) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
±èÁß¼±(Kim Jung-Sun) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
±èº´±Ø(Kim Byeong-Keuk) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
°í¿µ±¹(Ko Young-Guk) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
ÃÖµ¿ÈÆ(Choi Dong-Hoon) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
Àå¾ç¼ö(Jang Yang-Soo) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
È«¸í±â(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 ¡Â50 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.
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Aortic stenosis, renal insufficiency, transcatheter aortic valve replacement
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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).