PMID- 36699759
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230202
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 12
DP  - 2022 Dec
TI  - A Contrast Frugal Approach to Transcatheter Aortic Valve Replacement in Chronic 
      Kidney Disease: A Pilot Study.
PG  - e32878
LID - 10.7759/cureus.32878 [doi]
LID - e32878
AB  - BACKGROUND: Transcatheter aortic valve replacement (TAVR) is now regarded as a 
      viable treatment option for all cases of severe aortic stenosis (AS). Acute 
      kidney injury (AKI) is common and lowers the survival of patients after TAVR and 
      iodine-based contrast-induced nephropathy (CIN) plays a significant adverse role 
      in AKI. Therefore, in chronic kidney disease (CKD) patients requiring 
      pre-operative evaluation for TAVR, the risk of CIN is of particular concern. 
      METHODS: It was a single-center study including eight CKD patients who underwent 
      pre-operative evaluation for TAVR with minimized contrast exposure by means of 
      pre-operative contrast-sparing evaluation and intra-operative contrast 
      minimization. All patients had glomerular filtration rate (eGFR) calculated 
      before TAVR and on a follow-up about one month and one year post-operatively to 
      document the impact of this TAVR protocol on prognosis of kidney function in 
      patients with advanced CKD. RESULTS: New York Heart Association (NYHA) functional 
      classification demonstrated significant improvement of symptomatology (p = 
      0.0001) by one-year post-TAVR. Patients' mean AS gradient was significantly 
      improved (p = 0.00004) after the TAVR procedure. No significant post-operative 
      paravalvular aortic regurgitation was noted on follow up echocardiogram. eGFR 
      data showed mean eGFR for the group was slightly better (27.38 ml/min/per 1.73 
      m(2) BSA vs. 30.38 ml/min/per 1.73 m(2) BSA) after TAVR. CONCLUSIONS: "Contrast 
      frugal" approach is feasible and safe for pre-TAVR evaluation and the procedure 
      itself. Our pilot study showed no significant paravalvular leak of the prosthetic 
      valve following this proposed protocol. No statistically significant decrease in 
      eGFR was noted on a one-year follow-up.
CI  - Copyright (c) 2022, Bose et al.
FAU - Bose, Subhasish
AU  - Bose S
AD  - Internal Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, 
      USA.
AD  - Nephrology, University of Virginia, Lynchburg, USA.
AD  - Nephrology/Internal Medicine, Lynchburg General Hospital, Lynchburg, USA.
FAU - Kanda, Brinder
AU  - Kanda B
AD  - Internal Medicine, Liberty University College of Osreopathic Medicine, Lynchburg, 
      USA.
AD  - Cardiology, Centra Lynchburg General Hospital, Lynchburg, USA.
AD  - Cardiovascular Surgery, CMG Stroobant's Cardiovascular Center, Lynchburg, USA.
FAU - Roy, Sasmit
AU  - Roy S
AD  - Nephrology, University of Virginia, Lynchburg, USA.
AD  - Internal Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, 
      USA.
AD  - Nephrology, Centra Lynchburg General Hospital, Lynchburg, USA.
FAU - Saum, Kenneth
AU  - Saum K
AD  - Cardiovascular Surgery, Centra Lunchburg General Hospital, Lynchburg, USA.
FAU - Haas, John
AU  - Haas J
AD  - Cardiology, Centra Lynchburg General Hospital, Lynchburg, USA.
FAU - El-Adhab, Fadi
AU  - El-Adhab F
AD  - Cardiovascular Surgery, Centra Lynchburg General Hospital, Lynchburg, USA.
FAU - Ranson, Crystal
AU  - Ranson C
AD  - Cardiovascular Disease, Centra Lynchburg General Hospital, Lynchburg, USA.
FAU - Brunton, Nichole
AU  - Brunton N
AD  - Internal Medicine, Danbury Hospital, Danbury, USA.
FAU - Morford, Reagan
AU  - Morford R
AD  - Science and Technology, Central Virginia Governor's School, Lynchburg, USA.
FAU - Tavaf-Motamen, Houman
AU  - Tavaf-Motamen H
AD  - Cardiovascular Surgery, Centra Lynchburg General Hospital, Lynchburg, USA.
LA  - eng
PT  - Journal Article
DEP - 20221223
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9870599
OTO - NOTNLM
OT  - acute kidney injury
OT  - aortic stenosis
OT  - chronic kidney disease
OT  - contrast induced nephropathy
OT  - transcatheter aortic valve replacement
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/01/27 06:00
MHDA- 2023/01/27 06:01
PMCR- 2022/12/23
CRDT- 2023/01/26 02:49
PHST- 2022/11/11 00:00 [received]
PHST- 2022/12/23 00:00 [accepted]
PHST- 2023/01/26 02:49 [entrez]
PHST- 2023/01/27 06:00 [pubmed]
PHST- 2023/01/27 06:01 [medline]
PHST- 2022/12/23 00:00 [pmc-release]
AID - 10.7759/cureus.32878 [doi]
PST - epublish
SO  - Cureus. 2022 Dec 23;14(12):e32878. doi: 10.7759/cureus.32878. eCollection 2022 
      Dec.