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Transcatheter aortic valve replacement (TAVR) has emerged as a safe alternative for treating severe aortic stenosis (AS) in patients at moderate to high risk for surgery. However, the use of contrast and radiation during TAVR is not without adverse effects. We evaluated if Valve ASSIST2 (GE Healthcare, Waukesha, WI) (VA2), a fluoroscopy technology that enhances visualization of valve calcification, is associated with decreased volume of contrast and radiation dose and whether this translates into a reduction in contrast-induced nephropathy (CIN).
Patients who underwent TAVR using VA2 (n=129) were compared with routine fluoroscopy (n=266) between July 2015 and June 2016. CIN was defined as an increase in serum creatinine of 0.5 mg/dL from baseline. Chi-square tests were used to compare categorical data between groups. ANCOVA was used to adjust for age, sex, race, history of coronary disease, hypertension, diabetes and chronic kidney disease.
There was a significant difference in volume of contrast (45±25 vs. 68±30 ml, p<0.001) and radiation dose (485±413 vs. 630±514 mGy, p=0.006) between VA2 and control groups respectively (Fig 1A). After adjusting for covariates, there remained a significant difference in the amount of contrast used (F=5.460, p<0.001). There was a non-significant trend for reduced incidence of CIN (0.8% vs. 4%, p=0.091) (Fig 1B) for VA2 vs control group.
Use of VA2 was associated with a significant reduction in contrast volume and radiation dose as well as a trend favoring decreased incidence of CIN. Larger studies are needed to further elaborate these differences.
STRUCTURAL: Valvular Disease: Aortic