Why the study?
Although chronic kidney disease and acute kidney injury are linked to adverse outcomes after TAVR, the prognostic implications of renal function improvement following TAVR remain poorly understood.
Does renal improvement after TAVR improve survival time in patients undergoing transcatheter aortic valve replacement?
Does renal improvement after TAVR improve survival time in patients undergoing transcatheter aortic valve replacement?
Renal improvement after TAVR is associated with a significant survival benefit specifically in a high-risk subgroup of patients characterized by worse baseline renal function and heart failure severity.
Answers are grounded in this paper and cite their sources.
Post-TAVR renal improvement may indicate lower risk in observational data; leaves open whether it affects prognosis or warrants intervention.
BackgroundChronic kidney disease as well as acute kidney injury are associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). However, little is known about the prognostic implications of an improvement in renal function after TAVR. Methods Renal improvement (RI) was defined as a decrease in postprocedural creatinine in µmol/l of ≥ 1% compared to its preprocedural baseline value. A propensity score representing the likelihood of RI was calculated to define patient groups which were comparable regarding potential confounders (age, sex, BMI, NYHA classification, STS score, log. EuroSCORE, history of atrial fibrillation/atrial flutter, pulmonary disease, previous stroke, CRP, creatinine, hsTNT and NT-proBNP). The cohort was stratified into 5 quintiles according to this propensity score and the survival time after TAVR was compared within each subgroup. Results Patients in quintile 5 (n=93) had the highest likelihood for RI. They were characterized by higher creatinine, lower eGFR, higher NYHA class, higher NT-proBNP, being mostly female and having shorter overall survival time. Within quintile 5, patients without RI had significantly shorter survival compared to patients with RI (p=0.002). There was no survival time difference between patients with and without RI in the whole cohort (p=0.12) and in quintiles 1 to 4 (all p > 0.16).Conclusions We here describe a propensity score-derived specific subgroup of patients in which RI after TAVR correlated with a significant survival benefit.
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Frank et al. (2020) studied this question.