04 May How Do Patients With Compromised Kidney Function Do After TAVR?
MedicalResearch.com Interview with:
Dr. Beohar
Nirat Beohar, MD
Vice-Chief of Cardiology
Director Cardiac Catheterization Laboratory
Director Structural Heart Disease Program
Director Interventional Cardiology Fellowship program
Cardiac Catheterization Laboratory
Columbia University Division of Cardiology,
Mount Sinai Medical Center
Miami Beach, Miami, FL 33140
MedicalResearch.com: What is the background for this study?
Response: Nirat Beohar MD, Director of the Cardiovascular Catheterization Laboratory and Vice-Chief of Cardiology at the Columbia University Division of Cardiology at the Mount Sinai Medical Center and co-authors report the effect of trans-catheter aortic valve replacement (TAVR) on subsequent renal function and outcomes in high-risk and inoperable patients presenting with baseline renal dysfunction (eGFR < 60 ml/min/1.73 m2). This was a sub-study of patients undergoing TAVR in the PARTNER 1 trial and continued access registry that was conducted in 25 centers in the United States and Canada.
MedicalResearch.com: What are the main findings?
Response: The principal findings of the study were that:
1) baseline renal dysfunction was frequent (72%) among high-risk and inoperable patients with severe symptomatic AS undergoing TAVR
2) Despite having baseline renal dysfunction, 76% of patients experienced either a 10% or greater improvement in their eGFR (42% patients improved) or no change (34%) in their renal function after undergoing TAVR
3) At 1 year, after adjusting for baseline risk factors, a 10% or greater decline in eGFR (seen in 24% of patients) was associated with an increased hazard of all-cause mortality,
4) Predictors of improved eGFR were being female (odds ratio [OR], 1.38; 95%CI, 1.03-1.85; P = .03) and non-smoking status (OR, 1.49; 95%CI, 1.11-1.01; P = .01); while predictors of worsening eGFR were baseline left ventricle mass (OR, 1.00; 95%CI, 1.00-1.01; P = .01), smoking (OR, 1.51; 95%CI, 1.06-2.14; P = .02), and age (OR, 1.03; 95%CI, 1.00-1.05; P = .05); and predictors of 1-year mortality were baseline left ventricular ejection fraction (OR,0.98; 95%CI, 0.97-0.99; P = .003), baseline eGFR (OR,0.98; 95%CI,0.96-0.99; P < .001), and worsening eGFR vs no change in eGFR (OR, 1.51; 95%CI, 1.02-2.24; P = .04).
MedicalResearch.com: What should readers take away from your report?
Response: These findings on the one hand diminish the concern about offering this otherwise beneficial therapy to such patients with renal dysfunction but also emphasize the adverse prognostic effect of worsening renal function after TAVR and therefore the importance of developing techniques to minimize this decline.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Further research if needed to develop techniques to minimize a decline in renal function after TAVR. Further studies are also needed to look at TAVR outcomes among those with severe renal insufficiency (baseline serum creatinine >3mg/dL) and those on dialysis who were not included in the present analysis since they were excluded from the PARTNER trial and nonrandomized
continued access registries.
No relevant disclosures.
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Last Updated on May 4, 2017 by Marie Benz MD FAAD