Transfemoral Transkateter Aort Valv İmplantasyonu Sonrası Kontrast Bağımlı Nefropati Gelişiminde Femoral Giriş Yönteminin Önemi

Year 2016, Volume: 19 Issue: 2, 76 - 84, 01.08.2016

İlker Gül Mustafa Zungur Ahmet Taştan Muhammed Esad Çekin Ahmet Çağrı Aykan Aysel İslamlı Talat Tavlı

Abstract

Giriş:
Transkateter aort valv implantasyonu (TAVİ) yöntemi
cerrahi kapak replasmanı açısından yüksek riskli veya opere edilemeyen ileri
aort darlığı hastalarında daha güvenilir bir yöntemdir. Biz bu çalışmada
transfemoral (TF)-TAVİ sonrası farklı femoral giriş metodlarının, vasküler
komplikasyonlar ve kontrast bağımlı nefropati (KBN) gelişimi üzerine olan
etkilerini araştırmayı amaçladık.

Hastalar
ve Yöntem: Haziran 2013-Nisan 2015
tarihleri arasında TAVİ yöntemiyle aort valv replasmanı yapılan 110 hasta (yaş=
78.9 ± 12.2 yıl, 55 kadın) çalışmaya dahil edildi. KBN, TF-TAVİ’den 48-72 saat
sonra serum kreatinin değerinde > 0.5 mg/dL artış veya başlangıca göre
%25’ten daha fazla yükselme olarak tanımlandı. Hastalar vasküler giriş
yöntemlerine göre cerrahi cut-down (SCD) ve vasküler kapama cihazı (VCD) olarak
iki gruba ayırıldı.

Bulgular:
Kontrast madde (KM) miktarı (p< 0.001) ve KBN
insidansı (p= 0.038) VCD grubunda fazlaydı. Bazal glomerüler filtrasyon oranı
(GFO), bazal kreatinin, Mehran skoru ve KM’nin, KBN gelişiminin belirleyicileri
oldukları saptandı. ROC analizleri sonucunda; KBN gelişimini belirleyici KM
değerinin 178.5 mL ve GFO’nun 48.9 mL/dakika/1.73 m² olduğu
belirlendi.

Sonuç:
Çeşitli nedenlerle kullanılacak KM miktarı
artabilecek, GFO 48.9’un altında olan TAVİ hastalarında femoral arteriyel
prosedürler için VCD yerine SCD yöntemi tercih edilebilir.

Keywords

Kontrast bağımlı nefropati, transkateter aort valv implantasyonu, femoral arter, vasküler kapama cihazı, cerrahi cut-down

Importance of Femoral Access Method in Predicting the Development of Contrast Induced Nephropathy after Transfemoral Transcatheter Aortic Valve Implantation

Abstract

Introduction:
Transcatheter aortic valve implantation (TAVI) is
more reliable than surgical valve replacement for high-risk or inoperable
aortic stenosis patients. In this study, we aimed to investigate the effects of
different femoral access methods on the development of vascular complications
and contrast-induced nephropathy (CIN) after transfemoral (TF)-TAVI.

Patients
and Methods: In total, 110 patients (aged 78.9 ± 12.2
years; 55 females) who underwent aortic valve replacement by TF-TAVI between
June 2013 and April 2015 were included in the study. CIN was defined as an
absolute increase in serum creatinine level of > 0.5 mg/dL or a relative
increase of > 25% within 48-72 h after TF-TAVI. The patients were classified
into two groups according to the femoral access methods: surgical cut-down
(SCD) and vascular closure device (VCD) groups.

Results:
The amount of contrast medium (CM; p< 0.001) and
the incidence of CIN (p= 0.038) were higher in the VCD group. Baseline
glomerular filtration rate (GFR), baseline creatinine, Mehran score and CM were
determined as the predictive factors of CIN development. Receiver operating
characteristic analysis revealed that CM, which may predict the development of
CIN, was determined as 178.5 mL, and GFR, which may predict the development of
CIN, was determined as 48.9 mL/dk/1.73 m².

Conclusion:
It may be preferred to perform the femoral arterial
procedure using the SCD method instead of VCD in TAVI patients whose GFR is
< 48.9; the use of CM may increase due to various reasons.

Keywords

Contrast induced nephropathy, transcatheter aortic valve implantation, femoral artery, vascular closure device, surgical cut-down

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