Silvia Mas-Peiro1,2, Gloria Faerber3, Dimitra Bon2,4, Eva Herrmann2,4, Timm Bauer5, Sabine Bleiziffer6, Raffi Bekeredjian7, Andreas Böning8, Christian Frerker9, Andreas Beckmann10, Helge Möllmann11, Mariuca Vasa-Nicotera1,2, Stephan Ensminger12, Christian W Hamm2,13, Friedhelm Beyersdorf14,15, Stephan Fichtlscherer1,2, Thomas Walther2,16. 1. Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany. 2. German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Rhine-Main, Germany. 3. Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany. 4. Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt am Main, Frankfurt am Main, Germany. 5. Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany. 6. Department of Cardiothoracic Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany. 7. Department of Cardiology, Robert-Bosch Hospital, Stuttgart, Germany. 8. Department of Cardiothoracic Surgery, University Hospital Giessen, Giessen, Germany. 9. Department of Internal Medicine III, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany. 10. German Society of Thoracic and Cardiovascular Surgery, Langenbeck-Virchow-Haus, Berlin, Germany. 11. Department of Cardiology, St. Johannes Hospital, Dortmund, Germany. 12. Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany. 13. Department of Cardiology Kerckhoff Campus, University of Giessen, Giessen, Germany. 14. Department of Cardiovascular Surgery, University Heart Center Freiburg - Bad Krozingen, University Hospital Freiburg, Freiburg, Germany. 15. Medical Faculty of the Albert-Ludwigs-University Freiburg, Freiburg, Germany. 16. Department of Cardiothoracic Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.
Abstract
OBJECTIVES: Chronic kidney disease (CKD) is a key risk factor in patients undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). We analysed the impact of estimated glomerular filtration rate (eGFR) and CKD stages on their mid-term survival. METHODS: Data from 29 893 patients enrolled in the German Aortic Valve registry from January 2011 to December 2015 receiving TAVI (n = 12 834) or SAVR (n = 17 059) at 88 sites were included. The impact of renal impairment, as measured by eGFR and CKD stages, was investigated. The primary end-point was 1-year cumulative all-cause mortality. RESULTS: Higher CKD stages were significantly associated to lower in-hospital, 30-day- and 1-year survival rates. Both TAVI- and SAVR-treated patients in CKD 3a, 3b, 4 and 5 stages showed significant and gradually increasing HR values for 1-year all-cause mortality. The same trend persisted in multivariable analysis, although HR values for CKD 3a and 5 did not reach significance in TAVI patients, whereas CKD 4 + 5 did not reach statistical significance in SAVR. Likewise, eGFR as a continuous variable was a significant predictor for 1-year mortality, with the best cut-off points being 47.4 ml/min/1.73 m2 for TAVI and 59.8 ml/min/1.73 m2 for SAVR. Significant 8.6% and 9.0% increases in 1-year mortality were observed for every 5-ml reduction in eGFR for TAVI and SAVR, respectively. CONCLUSIONS: CKD ≥3b and CKD ≥3a are the independent major risk factors for mortality in patients undergoing TAVI and SAVR, respectively. In the overall population of patients with severe aortic stenosis, an appropriate stratification based on CKD substage may contribute to a better selection of patients suitable for such therapies.
OBJECTIVES:Chronic kidney disease (CKD) is a key risk factor in patients undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). We analysed the impact of estimated glomerular filtration rate (eGFR) and CKD stages on their mid-term survival. METHODS: Data from 29 893 patients enrolled in the German Aortic Valve registry from January 2011 to December 2015 receiving TAVI (n = 12 834) or SAVR (n = 17 059) at 88 sites were included. The impact of renal impairment, as measured by eGFR and CKD stages, was investigated. The primary end-point was 1-year cumulative all-cause mortality. RESULTS: Higher CKD stages were significantly associated to lower in-hospital, 30-day- and 1-year survival rates. Both TAVI- and SAVR-treated patients in CKD 3a, 3b, 4 and 5 stages showed significant and gradually increasing HR values for 1-year all-cause mortality. The same trend persisted in multivariable analysis, although HR values for CKD 3a and 5 did not reach significance in TAVI patients, whereas CKD 4 + 5 did not reach statistical significance in SAVR. Likewise, eGFR as a continuous variable was a significant predictor for 1-year mortality, with the best cut-off points being 47.4 ml/min/1.73 m2 for TAVI and 59.8 ml/min/1.73 m2 for SAVR. Significant 8.6% and 9.0% increases in 1-year mortality were observed for every 5-ml reduction in eGFR for TAVI and SAVR, respectively. CONCLUSIONS: CKD ≥3b and CKD ≥3a are the independent major risk factors for mortality in patients undergoing TAVI and SAVR, respectively. In the overall population of patients with severe aortic stenosis, an appropriate stratification based on CKD substage may contribute to a better selection of patients suitable for such therapies.
Authors: Alexander Hof; Simon Geißen; Kezia Singgih; Martin Mollenhauer; Holger Winkels; Thomas Benzing; Stephan Baldus; Friedrich Felix Hoyer Journal: Basic Res Cardiol Date: 2022-07-27 Impact factor: 12.416
Authors: Maria Zisiopoulou; Alexander Berkowitsch; Ralf Neuber; Haralampos Gouveris; Stephan Fichtlscherer; Thomas Walther; Mariuca Vasa-Nicotera; Philipp Seppelt Journal: J Pers Med Date: 2022-02-24