Abstract
The study objective was to evaluate the impact of the amount of contrast medium used for transcatheter aortic valve implantation (TAVI) on short-term outcome. Patients undergoing TAVI are exposed to repeat contrast medium application both for preprocedural screening and during the TAVI procedure itself. Whether the amount of contrast media is associated with worse outcome is unclear. A total of 257 patients were included (median age 82.7 years) and divided into two groups with preserved and reduced kidney function (glomerular filtration rate <60 ml/min/1.73 m2), respectively. Total volume of contrast media administered during and within 5 days prior to TAVI was analysed. A combined early safety endpoint at 30 days was evaluated. The early safety endpoint was reached by 31 patients and acute kidney injury occurred in 22 patients. The median total volume of contrast media administered was 144 ml (interquartile range 81-225 ml). The amount of contrast did not independently predict the early safety endpoint in the overall population (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.56 to 1.53, p = 0.774) and in subgroups with preserved and reduced kidney function. Change in creatinine was an independent strong predictor of the early safety endpoint in the overall population (OR 18.13, 95% CI 4.70 to 69.99, p <0.001), as well as in subgroups with preserved and reduced kidney function. The amount of contrast did not predict a change in creatinine within 72 hours following TAVI (r = 0.02, 95% CI -0.02 to 0.07, p = 0.368). Decreased kidney function after TAVI influences outcome. When rather small amounts of contrast media are used for screening and the TAVI procedure itself, the amount of contrast media seems not to be an independent predictor of outcome, further suggesting that decreased kidney function after TAVI is multifactorial.
Highlights
Transcatheter aortic valve implantation (TAVI) has become an accepted percutaneous procedure for the treatment of advanced aortic valve disease [1]
In only 91 (35.4%) and 57 (22.2%) patients, respectively, computed tomography (CT) and cardiac catheterisation were performed within the critical 5-day period prior to transcatheter aortic valve implantation (TAVI)
The median amount of contrast media administered during TAVI was 99 ml (IQR 65–147 ml)
Summary
Transcatheter aortic valve implantation (TAVI) has become an accepted percutaneous procedure for the treatment of advanced aortic valve disease [1]. The mean age range of patients undergoing TAVI in high-volume registries has been reported to be between 81 and 84 years old, and the prevalence of comorbidities such as chronic obstructive pulmonary disease (COPD), coronary and peripheral artery disease, as well as chronic kidney disease (CKD), arterial hypertension and diabetes is high [2,3,4,5,6]. Preprocedural screening includes – besides echocardiography – investigations necessitating application of contrast media (coronary angiography, aortic root angiography, peripheral angiography, computed tomography). This is followed by repeat contrast media application during the TAVI procedure itself. The volume of contrast media is considered a major risk factor associated with AKI in patients undergoing percu-
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