Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation: Insights on clinical outcomes and prognostic markers froma large cohort of patients

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: 1.47.3.58, P= 0.001) and dialysis therapy (HR: 1.86, 95% CI: 1.17.2.97, 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.