Author + information
- Received June 3, 2020
- Revision received July 15, 2020
- Accepted July 20, 2020
- Published online September 14, 2020.
- Robert J. Cubeddu, MDa,∗ (, )@RCubedduMD,
- Craig R. Asher, MDa,
- Ashley M. Lowry, MSb,
- Eugene H. Blackstone, MDb,c,
- Samir R. Kapadia, MDd,
- Maria C. Alu, MSe,
- Vinod H. Thourani, MDf,
- Michael J. Mack, MDg,
- Susheel K. Kodali, MDh,
- Howard C. Herrmann, MDi,
- Jessica Forcillo, MD, MScj,
- Vasilis C. Babaliaros, MDk,
- Chandan M. Devireddy, MDl,
- S. Chris Malaisrie, MDm,
- Charles J. Davidson, MDn,
- Wael A. Jaber, MDd,
- Martin B. Leon, MDe,
- Lars G. Svensson, MD, PhDc,
- for the PARTNER Trial Investigators
- aCardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Weston, Weston, Florida
- bQuantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
- cThoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- dCardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- eCenter for Interventional Vascular Therapy, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
- fCardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart and Vascular Institute, Atlanta, Georgia
- gCardiothoracic Surery, Baylor Scott & White Health, Plano, Texas
- hStructural Heart and Valve Center, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
- iCardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- jCardiac Surgery, University of Montreal Hospital Centre, Montreal, Quebec, Canada
- kStructural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
- lCardiology, Emory University School of Medicine, Atlanta, Georgia
- mCardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois
- nCardiovascular Medicine, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois
- ↵∗Address for correspondence:
Dr. Robert J. Cubeddu, Department of Cardiology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, Florida 33331.
Background The effect of transcatheter aortic valve replacement (TAVR) on kidney function stage in patients with aortic stenosis remains poorly understood. We hypothesized that in some patients, TAVR results in improved kidney function by alleviating cardiorenal syndrome.
Objectives The purpose of this study was to assess change in chronic kidney disease (CKD) stage following TAVR, identify variables associated with pre- and post-TAVR estimated glomerular filtration rate (eGFR), and assess association of post-TAVR eGFR with mortality.
Methods Patients (n = 5,190) receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) 1, 2, and PARTNER 2 S3 trials between April 2007 and October 2014 were included. Pre-TAVR and procedural variables associated with post-TAVR eGFR, change in CKD stage at ≤7 days post-TAVR, and association of post-TAVR eGFR on intermediate-term mortality were assessed.
Results At baseline, CKD stage ≥2 was present in 91% of patients. CKD stage either improved or was unchanged following TAVR in the majority of patients (77% stage 1, 90% stage 2, 89% stage 3A, 94% stage 3B, and 99% stage 4). Progression to CKD stage 5 occurred in 1 (0.035%) of 2,892 patients within 7 days post-TAVR. Of 3,546 patients in whom data were available, 70 (2.0%) underwent post-TAVR dialysis. Higher pre-TAVR eGFR and transfemoral approach were strongly associated with higher post-TAVR eGFR. Lower baseline and longitudinal post-TAVR eGFR were associated with lower intermediate-term survival.
Conclusions In patients with severe aortic stenosis undergoing TAVR, even with baseline impaired eGFR, CKD stage is more likely to stay the same or improve than worsen. Aortic stenosis may contribute to cardiorenal syndrome that improves with TAVR.
The PARTNER Trial was funded by Edwards Lifesciences. This study was supported in part by the Drs. Sidney and Becca Fleischer Heart and Vascular Education Chair and The Delos M. Cosgrove, MD, Chair for Heart Disease Research. Dr. Cubeddu has received fees for educational speaker and proctor-related activities through Edwards Lifesciences and Abbott Vascular. Dr. Blackstone serves as head of the Cleveland Clinic PARTNER Publications Office, which carries out independent analyses of data stemming from the PARTNER trials. Dr. Thourani serves as an advisor for Edwards Lifesciences, Abbott Vascular, Gore Vascular, Bard Medical, JenaValve, and Boston Scientific. Drs. Mack, Leon, and Svensson are members of the PARTNER Trial Executive Committee (no direct compensation). Dr. Kodali has received consulting fees from Edwards Lifesciences and Claret Medical; and serves on the Advisory Boards of Thubrikar Aortic Valve, Inc., Duratech, and VS Medtech. Dr. Herrmann has received institutional research funding from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received consulting fees from Abbott Vascular, Edwards Lifesciences, and Medtronic. Dr. Forcillo is an advisor for Medtronic and Edwards Lifesciences. Dr. Babaliaros serves as a consultant for Edwards Lifesciences; and has equity with Transmural Systems. Dr. Devireddy has received consulting fees from Medtronic, ReCor Medical, Shockwave Medical, and Vascular Dynamics. Dr. Leon has received research grants from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This paper was presented at the 2018 30th Annual Transcatheter Cardiovascular Therapeutics Meeting, on September 21 to 25, 2018, in San Diego, California. Benjamin Galper, MD, MPH, served as Guest Associate Editor for this paper. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received June 3, 2020.
- Revision received July 15, 2020.
- Accepted July 20, 2020.
- 2020 American College of Cardiology Foundation
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