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

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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