Aim Theaimof this studywastodeterminetheeffects ofadvancedchronic kidneydisease(CKD)onearlyandlateoutcomes after transcatheter aortic valve implantation (TAVI), and to evaluate the predictive factors of poorer outcomes in such patients. Methods and results This was a multicentre study including a total of 2075 consecutive patients who had undergone TAVI. Patients were grouped according the estimated glomerular filtration rate as follows: CKD stage 1-2 (≥60 mL/min/1.73 m2; n = 950), stage 3 (30-59 mL/min/1.73 m2; n= 924), stage 4 (15.29 mL/min/1.73 m2; n= 134) and stage 5 (,15 mL/ min/1.73 m2 or dialysis; n= 67). Clinical outcomes were evaluated at 30-days and at follow-up (median of 15 [6.29] months) and defined according to the VARC criteria. Advanced CKD (stage 4.5) was an independent predictor of 30-day major/life-threatening bleeding (P= 0.001) and mortality (P= 0.027), and late overall, cardiovascular and noncardiovascular mortality (P < 0.01 for all). Pre-existing atrial fibrillation (HR: 2.29, 95% CI: 184.108.40.206, P= 0.001) and dialysis therapy (HR: 1.86, 95% CI: 220.127.116.11, P= 0.009)were the predictors of mortality in advanced CKDpatients, with a mortality rate as high as 71% at 1-year follow-up in those patients with these 2 factors. Advanced CKD patients who had survived at 1-year follow-up exhibited both a significant improvement inNYHAclass (P < 0.001) and no deterioration in valve hemodynamics (P= NS for changes in mean gradient and valve area over time). Conclusions AdvancedCKDwas associatedwith a higher rate of early and latemortality and bleeding events followingTAVI,with AFand dialysis therapy determining a higher risk in these patients. Themortality rate of patientswith both factorswas unacceptably high and this should be taken into account in the clinical decision-making process in this challenging group of patients.
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