KONAMI Yutaka    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Assistant Professor
Language	English
Title	Preoperative Transaortic Pressure Gradient Predicts Renal Functional Improvement after Transcatheter Aortic Valve Implantation in Patients with Chronic Kidney Disease
Conference	第 84 回日本循環器学会学術集会
Conference Type	Nationwide Conferences
Presentation Type	Speech
Lecture Type	General
Publisher and common publisher	TAKADA Takuma, JUJO Kentaro, KONAMI Yutaka, OOTSUKI Hisao, TANAKA Kazuki, ISOMURA Shogo, DOMOTO Satoru, YAMAGUCHI JUNICHI, NIINAMI Hiroshi, Nobuhisa Hagiwara
Date	2020/07/27
Venue (city and name of the country)	Kyoto (Online)
Summary	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.