Key result
Integrated TAVI with gadolinium-free MR linked to ~64% lower contrast use in severe CKD.
Why the study?
Patients with severe kidney disease and severe aortic stenosis requiring TAVI represent a growing cohort, prompting evaluation of approaches to minimize contrast media use.
Does a novel integrated approach including gadolinium-free MR improve safety by minimizing contrast media use in patients with severe kidney disease and severe aortic stenosis requiring TAVI?
Cohort (n=168)
Does a novel integrated approach including gadolinium-free MR improve safety by minimizing contrast media use in patients with severe kidney disease and severe aortic stenosis requiring TAVI?
A novel integrated approach using gadolinium-free MR is being investigated to minimize contrast media use in high-risk TAVI patients with severe kidney disease.
Answers are grounded in this paper and cite their sources.
Gadolinium-free MR may enable contrast minimization during TAVI in severe CKD; leaves open whether this improves safety or outcomes.
Background: Patients with severe kidney disease and severe aortic stenosis requiring transcatheter aortic valve implantation (TAVI) represent a growing cohort.In this context, we investigated the feasibility and safety of a novel integrated approach, including gadolinium-free magnetic resonance tomography (MR) in order to minimize use of any contrast media (CM) in those patients.Methods and results: Out of a cohort of 168 patients undergoing TAVI, 20 (12%) patients with severe chronic kidney disease (CKD) were managed by applying an integrated approach using minimal dosage of CM.Coronary angiographies were performed with 54±35 ml and 85±44 ml of CM in patients with severe CKD and patients without severe CKD, respectively (p <0.01).In patients with severe CKD, gadolinium-free magnetic resonance tomographies (MR) were performed for annular and iliofemoral assessment.All other patients were screened with ECGgated multislice computed tomography using 63±14 ml of CM.In patients with severe versus without severe CKD, TAVIs were performed with 40± 32 ml versus 112±50 ml of contrast media, respectively (p <0.01).During followup, stage 2 or 3 acute kidney injury (AKI) occurred in 1 (5%) versus 4 (2.8%, p = 0.05).At 30 days, there were no strokes, and survival was 100% and 98%, respectively.Conclusions: We were able to reduce the total amount of CM required for pre-procedural planning and TAVI by 64% from 260±79 ml to 94±54 ml.This study indicates that gadolinium-free MR can be used for pre-procedural annular and iliofemoral assessment, and thus selection of prosthesis size.
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Brinkert et al. (2019) conducted a cohort in Severe aortic stenosis and severe chronic kidney disease requiring transcatheter aortic valve implantation (n=168). Integrated minimal contrast media approach including gadolinium-free magnetic resonance tomography vs. Standard TAVI workup with ECG-gated multislice computed tomography in patients without severe CKD was evaluated on Total contrast media volume (ml) and stage 2 or 3 acute kidney injury (p=0.05). An integrated TAVI approach with gadolinium-free MR in severe CKD reduced total contrast media by 64%, with stage 2/3 AKI in.
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