Non-contrast transoesophageal echo-guided transapical transcatheter aortic valve replacement: 10-year experience of a renoprotective strategy.

Autor:	Mosquera VX; Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain., Bouzas-Mosquera A; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.; Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain., Vilela-González Y; Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain., Oujo-González B; Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain., Velasco-García C; Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain., Cuenca-Castillo JJ; Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain., Herrera-Noreña JM; Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
Jazyk:	angličtina
Zdroj:	Interactive cardiovascular and thoracic surgery [Interact Cardiovasc Thorac Surg] 2021 Jul 26; Vol. 33 (2), pp. 195-202.
DOI:	10.1093/icvts/ivab080
Abstrakt:	Objectives: This study aims to evaluate the efficacy, safety and long-term outcomes of a renoprotective non-contrast, transoesophageal echocardiography-guided transapical (TA) transcatheter aortic valve replacement (TAVR) strategy with a balloon-expandable prosthesis, as well as to determine its impact on renal function. Methods: Between 2009 and 2019, 200 consecutive patients underwent a non-contrast, transoesophageal echocardiography-guided TA TAVR with a balloon-expandable prosthesis. Results: The device success rate was 95.5%. Transoesophageal echocardiography-guided deployment demonstrated a low rate of procedure-related complications: 9.5% of acute kidney injury, 8% postoperative bleeding, 6% low-cardiac output, 4.5% postprocedural aortic regurgitation ≥+2, 4% implantation of permanent pacemaker and 2% stroke. There were no significant differences between preoperative and on discharge estimated glomerular filtration rate (53.9 ± 22.2 vs 54.3 ± 22.9 ml/min/1.73 m2, P = 0.60). Logistic regression analysis confirmed postoperative bleeding as an independent predictor for acute kidney injury (odds ratio (OR) 11.148, 95% confidence interval 3.537-35.140, P < 0.001). In-hospital mortality was 7.5%. The mean follow-up was 48.5 ± 39.9 months. Renal function and patient's chronic kidney disease stage did not significantly vary during follow-up. Long-term cumulative survival at 1, 5 and 10 years was 84.2 ± 0.027%, 42.9 ± 0.038% and 32.5 ± 0.044%, respectively. Renal function affected on neither in-hospital mortality nor long-term survival. Conclusions: Non-contrast, transoesophageal echocardiography-guided TA TAVR is a safe and reproducible technique with a low incidence of periprocedural complications that avoids the use of contrast and mitigates the incidence of acute kidney injury. (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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