Aortic Valve Stenosis/complications

ABC

Editorial

Impact of Transcatheter Aortic Valve Implantation on Kidney Function: the “Renovalvular” Interaction in Aortic Stenosis

The advent of renal congestion in heart failure was first described by Frédéric Justin Collet (1870-1966), a French pathologist who found the notion of passive renal congestion related to heart dysfunction, creating the revealing term “rein cardiaque” in the early 1900s. The term cardiorenal syndrome emerged from a 2004 National Heart, Lung, and Blood Institute Working GrouP conference evaluating the complex interactions between the heart and kidney. The main pathophysiological mechanisms related to this condition are increased central venous and intra-abdominal pressures; reduced cardiac output and cardiac index; neurohormonal dysregulation; oxidative stress and inflammatory mediators. Degenerative aortic stenosis (AS) represents one of the most prevalent valvular heart diseases and an important cause of heart failure, with a strong correlation with aging process. The combination of atherosclerosis, biomineralization and oxidative stress leads to calcium deposition within the valve leaflets. The “renovalvular” interaction in AS may represent a two-way path, from a pathophysiological perspective. In one way, AS may impair kidney function by arterial hypoperfusion and systemic venous congestion. On the other way, chronic kidney disease (CKD) is also an important risk factor for AS, due to the massive and aggressive calcification of the leaflets, mainly imposed by imbalances in the calcium and phosphorus homeostasis.

For patients with AS undergoing conventional surgical aortic valve replacement (AVR), there is an increase in complication rates such as major bleeding and reoperation when comparing patients with moderately reduced kidney function (estimated glomerular filtration rate [eGFR] between 30-60 ml/min/1.73 m) versus those without kidney disease. Mortality after surgical AVR also increases with worsening GFR.

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ABC

Original Article

Impact of Transcatheter Aortic Valve Implantation on Kidney Function

Rita Calça et al. Rui C. Teles Patrícia Branco Augusta Gaspar … João Brito Tiago Nolasco Manuel D. Almeida José P. Neves Miguel Mendes Domingos S. Machado André Weigert

Abstract

Background:

Chronic kidney disease (CKD) is frequently present in patients with aortic valve disease. Decreased kidney perfusion as a consequence of reduced cardiac output may contribute to renal dysfunction in this setting.

Objective:

Given the potential reversibility of kidney hypoperfusion after valve repair, this study aimed to analyze the impact of percutaneous transcatheter aortic valve implantation (TAVI) on kidney function.

Methods:

We performed a retrospective analysis of 233 consecutive patients who underwent TAVI in a single center between November 2008 and May 2016. We assessed three groups according to their baseline estimated glomerular filtration rate (eGFR) (mL/min/1.73 m²): Group 1 with eGFR ≥ 60; Group 2 with 30 ≤ eGFR < 60; and Group 3 with eGFR < 30. We analyzed the eGFR one month and one year after TAVI in these three groups, using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula to calculate it.

Results:

Patients from Group 1 had a progressive decline in eGFR one year after the TAVI procedure (p < 0.001 vs. pre-TAVI). In Group 2 patients, the mean eGFR increased one month after TAVI and continued to grow after one year (p = 0.001 vs. pre-TAVI). The same occurred in Group 3, with the mean eGFR increasing from 24.4 ± 5.1 mL/min/1.73 m² before TAVI to 38.4 ± 18.8 mL/min/1.73 m² one year after TAVI (p = 0.012).

Conclusions:

For patients with moderate-to-severe CKD, kidney function improved one year after the TAVI procedure. This outcome is probably due to better kidney perfusion post-procedure. We believe that when evaluating patients that might need TAVI, this ‘reversibility of CKD effect’ should be considered.

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IJCS

Editorial

Conduction Abnormalities after Transcatheter Aortic Valve Replacement: Pretty Common, Fairly Predictable, Barely Avoidable

Mohammad Abdelghani

The cardiac conduction system is commonly diseased in patients with aortic valve disease, and the site of conduction defect in those with severe calcific aortic valve stenosis is most commonly the His bundle or infra-Hisian.^, The bundle of His traverses the membranous septum towards the left ventricular outflow tract (LVOT) running superficially over the crest of the ventricular septum, originating the left bundle branch. This anatomical course makes the His bundle and its left branch susceptible to mechanical injury during transcatheter aortic valve replacement (TAVR), which involves multiple mechanical manipulations with wires, catheters, balloons, and the transcatheter heart valve (THV) inflow within that vicinity. Atrioventricular and intra-ventricular conduction abnormalities are indeed a common finding in patients with severe aortic valve stenosis referred to TAVR and new onset persistent conduction abnormalities (NOPCAs) are a common complication arising during/after TAVR.

Unlike other periprocedural complications of TAVR, whose incidence has decreased over time, a regression in the incidence of NOPCAs after TAVR was neither seen with the introduction of new TAVR technologies/techniques nor it is foreseeable in the near future.

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Impact of Transcatheter Aortic Valve Implantation on Kidney Function: the “Renovalvular” Interaction in Aortic Stenosis

Impact of Transcatheter Aortic Valve Implantation on Kidney Function

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

Conduction Abnormalities after Transcatheter Aortic Valve Replacement: Pretty Common, Fairly Predictable, Barely Avoidable

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