BACKGROUND: The impact of baseline renal dysfunction on early and late clinical outcomes after transcatheter aortic valve implantation (TAVI) remains to be defined. METHODS: 927 patients included in the prospective Bern TAVI registry were classified on the basis of the baseline estimated glomerular filtration rate (eGFR), as having none or mild (eGFR ≥60mL/min/1.73m2, n=284, 30.6%), moderate (eGFR between 30 and 59mL/min/1.73m2, n=535, 57.7%) and severe (eGFR <30mL/min/1.73m2, n=108, 11.7%) renal dysfunction. RESULTS: A graded relationship between stages of renal dysfunction and increasing risk profile was observed with higher STS score and lower left ventricular ejection fraction among patients with eGFR<30 (p<0.001 across groups). In patients with none or mild, moderate, and severe renal dysfunction the rate of all-cause mortality was 1.8%, 5.2% and 8.3% at 30-day and 11.0%, 15.0% and 19.5% at 1-year, respectively. After adjusting for relevant confounders, severe renal dysfunction was associated with an increased risk of cardiovascular death (adjusted Hazard Ratio, HRadj, 3.90, 95% Confidence Interval, CI 1.15-13.2) and stage 3 acute kidney injury (HRadj 5.15, 95% CI 1.72-15.5) at 30-day follow-up, however no significant association was found for clinical outcomes at 1-year follow-up. Moreover, moderate and severe renal dysfunction were found to be associated with bleeding at 1-year follow-up (HRadj, 1.36, 95% CI 1.04-1.78 and HRadj 1.49, 95% CI 1.00-2.21, respectively). CONCLUSIONS: Pre-procedural renal dysfunction differentially affects early clinical outcomes, although the magnitude of this association is diluted over time by the overriding effect of underlying risk and comorbidities.
BACKGROUND: The impact of baseline renal dysfunction on early and late clinical outcomes after transcatheter aortic valve implantation (TAVI) remains to be defined. METHODS: 927 patients included in the prospective Bern TAVI registry were classified on the basis of the baseline estimated glomerular filtration rate (eGFR), as having none or mild (eGFR ≥60mL/min/1.73m2, n=284, 30.6%), moderate (eGFR between 30 and 59mL/min/1.73m2, n=535, 57.7%) and severe (eGFR <30mL/min/1.73m2, n=108, 11.7%) renal dysfunction. RESULTS: A graded relationship between stages of renal dysfunction and increasing risk profile was observed with higher STS score and lower left ventricular ejection fraction among patients with eGFR<30 (p<0.001 across groups). In patients with none or mild, moderate, and severe renal dysfunction the rate of all-cause mortality was 1.8%, 5.2% and 8.3% at 30-day and 11.0%, 15.0% and 19.5% at 1-year, respectively. After adjusting for relevant confounders, severe renal dysfunction was associated with an increased risk of cardiovascular death (adjusted Hazard Ratio, HRadj, 3.90, 95% Confidence Interval, CI 1.15-13.2) and stage 3 acute kidney injury (HRadj 5.15, 95% CI 1.72-15.5) at 30-day follow-up, however no significant association was found for clinical outcomes at 1-year follow-up. Moreover, moderate and severe renal dysfunction were found to be associated with bleeding at 1-year follow-up (HRadj, 1.36, 95% CI 1.04-1.78 and HRadj 1.49, 95% CI 1.00-2.21, respectively). CONCLUSIONS: Pre-procedural renal dysfunction differentially affects early clinical outcomes, although the magnitude of this association is diluted over time by the overriding effect of underlying risk and comorbidities.