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Impact of renal function on survival after transcatheter aortic valve implantation (TAVI): an analysis of the UK TAVI registry
  1. Charles J Ferro1,
  2. Colin D Chue1,
  3. Mark A de Belder2,
  4. Neil Moat3,
  5. Olaf Wendler4,
  6. Uday Trivedi5,
  7. Peter Ludman1,
  8. Jonathan N Townend1
  9. On behalf of the UK TAVI Steering group and the National Institute for Cardiovascular Outcomes Research
  1. 1Birmingham Cardio-Renal Group, Birmingham Health Partners, Queen Elizabeth Hospital, Birmingham, UK
  2. 2Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
  3. 3Department of Cardiology, Royal Brompton and Harefield Hospitals, London, UK
  4. 4Department of Cardiothoracic Surgery, King's College Hospital/King's Health Partners, London, UK
  5. 5Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
  1. Correspondence to Dr Charles J Ferro, Department of Nephrology, Queen Elizabeth Hospital, Birmingham B15 2WB, UK, charles.ferro{at}uhb.nhs.uk

Abstract

Objective To determine the nature of the association between renal dysfunction and outcomes following transcatheter aortic valve implantation (TAVI) in all cases performed in the UK between 2007 and 2012.

Methods The UK TAVI registry was established to report outcomes on all TAVI procedures performed within the UK. Data were collected prospectively on 3980 patients from 1 January 2007 until 31 December 2012.

Results In total, 205 patients (5.5%) died during their admission. Moderate to advanced chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2) was significantly associated with increased mortality, even after adjustment for risk factors (OR 1.45, 95% CI 1.03 to 2.05; p=0.04). For every 10 mL/min/1.73 m2 decrease in eGFR, in-hospital mortality increased by 8.2% (95% CI 1.1% to 14.7%; p=0.03). In total 1119 patients (30.2%) died during the follow-up period (median 543 days). Moderate to advanced CKD (eGFR <45 mL/min/1.73 m2) was significantly associated with increased mortality, even after adjustment for risk factors (OR 1.36, 95% CI 1.17 to 1.58; p<0.001). For every 10 mL/min/1.73 m2 decrease in eGFR, cumulative mortality increased by 4.4% (95% CI 1.2% to 7.5%; p=0.007). Preoperative kidney function and the need for preoperative dialysis treatment discriminated between patients who died and survived. However, predictive power was poor with none of the c-statistics being >0.6.

Conclusions Pre-procedural renal dysfunction is associated, in a graded fashion independently of dialysis status, with worse outcomes, including mortality in patients undergoing TAVI.

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