ニイナミ　ヒロシ   Niinami Hiroshi   新浪　博    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
言語種別	英語
発表タイトル	Preoperative Transaortic Pressure Gradient Predicts Renal Functional Improvement after Transcatheter Aortic Valve Implantation in Patients with Chronic Kidney Disease
会議名	第 84 回日本循環器学会学術集会
学会区分	全国規模の学会
発表形式	口頭
講演区分	一般
発表者・共同発表者	TAKADA Takuma, JUJO Kentaro, KONAMI Yutaka, OOTSUKI Hisao, TANAKA Kazuki, ISOMURA Shogo, DOMOTO Satoru, YAMAGUCHI JUNICHI, NIINAMI Hiroshi, Nobuhisa Hagiwara
発表年月日	2020/07/27
開催地 （都市, 国名）	Kyoto (Online)
概要	Background: Transcatheter aortic valve implantation (TAVI) theoretically increases renal blood flow through increasing cardiac output, resulting in a renal functional (RF) recovery in patients with severe aortic valve stenosis (AS). However, procedural steps of TAVI including contrast use potentially damage renal medulla and may deteriorate renal function. We aimed to clarify preoperative predictors for RF improvement after TAVI in chronic kidney disease (CKD) patients with severe AS. Methods: This observational study included 121 consecutive patients with severe AS and CKD (grade >3) who underwent TAVI. They were divided into two groups depending on their RF improvement after TAVI that was defined as >10% increase in estimated glomerular filtration rate (eGFR) at discharge from their preoperative level. Results: Among the whole candidates, 65 patients (54%) achieved RF improvement after TAVI. Patients with the lower preoperative eGFR tended to achieve the higher increase in eGFR after TAVI (r=-0.17, p=0.059). Multivariate logistic regression analysis revealed that high mean transaortic pressure gradient (TAPG) and E/e´ before TAVI were independent predictors for RF improvement (adjusted odds ratio (aOR): 1.03, 95% confidence interval (CI): 1.00-1.07 and aOR: 0.93, 95%CI: 0.88-0.99, respectively), even after the adjustment of baseline parameters that were significant on univariate analysis. The cut-off levels of preoperative mean TAPG and E/e´ in RF improvement after TAVI were 47.0 mmHg and 13.8, respectively. Conclusions: Preoperative high mean TAPG and low E/e´ could predict RF improvement after TAVI in patients with deteriorated renal function. Clinicians may have choice to consider TAVI in AS patients with preoperative high TAPG, even in those with impaired renal functions.