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. 2022 Dec 23;14(12):e32878.
doi: 10.7759/cureus.32878. eCollection 2022 Dec.

A Contrast Frugal Approach to Transcatheter Aortic Valve Replacement in Chronic Kidney Disease: A Pilot Study

Subhasish Bose  1   2   3 , Brinder Kanda  4   5   6 , Sasmit Roy  2   1   7 , Kenneth Saum  8 , John Haas  5 , Fadi El-Adhab  9 , Crystal Ranson  10 , Nichole Brunton  11 , Reagan Morford  12 , Houman Tavaf-Motamen  9
Affiliations

A Contrast Frugal Approach to Transcatheter Aortic Valve Replacement in Chronic Kidney Disease: A Pilot Study

Subhasish Bose et al. Cureus. .

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is now regarded as a viable treatment option for all cases of severe aortic stenosis (AS). Acute kidney injury (AKI) is common and lowers the survival of patients after TAVR and iodine-based contrast-induced nephropathy (CIN) plays a significant adverse role in AKI. Therefore, in chronic kidney disease (CKD) patients requiring pre-operative evaluation for TAVR, the risk of CIN is of particular concern.

Methods: It was a single-center study including eight CKD patients who underwent pre-operative evaluation for TAVR with minimized contrast exposure by means of pre-operative contrast-sparing evaluation and intra-operative contrast minimization. All patients had glomerular filtration rate (eGFR) calculated before TAVR and on a follow-up about one month and one year post-operatively to document the impact of this TAVR protocol on prognosis of kidney function in patients with advanced CKD.

Results: New York Heart Association (NYHA) functional classification demonstrated significant improvement of symptomatology (p = 0.0001) by one-year post-TAVR. Patients' mean AS gradient was significantly improved (p = 0.00004) after the TAVR procedure. No significant post-operative paravalvular aortic regurgitation was noted on follow up echocardiogram. eGFR data showed mean eGFR for the group was slightly better (27.38 ml/min/per 1.73 m2 BSA vs. 30.38 ml/min/per 1.73 m2 BSA) after TAVR.

Conclusions: "Contrast frugal" approach is feasible and safe for pre-TAVR evaluation and the procedure itself. Our pilot study showed no significant paravalvular leak of the prosthetic valve following this proposed protocol. No statistically significant decrease in eGFR was noted on a one-year follow-up.

Keywords: acute kidney injury; aortic stenosis; chronic kidney disease; contrast induced nephropathy; transcatheter aortic valve replacement.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Arrows showing patent blood circulation through aortic branches
Figure 2
Figure 2. Transesophageal echocardiogram TAVR Sizing
TAVR: Transcatheter aortic valve replacement
See this image and copyright information in PMC

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