Non-contrast transesophageal echo-guided transapical transcatheter aortic valve replacement: 10-year experience of a renoprotective strategy.

Abstract

OBJECTIVES\nThis study aims to evaluate the efficacy, safety and long-term outcomes of a renoprotective non-contrast, transoesophageal echocardiography-guided transapical (TA) transcatheter aortic valve replacement (TAVR) strategy with a balloon-expandable prosthesis, as well as to determine its impact on renal function.\n\n\nMETHODS\nBetween 2009 and 2019, 200 consecutive patients underwent a non-contrast, transoesophageal echocardiography-guided TA TAVR with a balloon-expandable prosthesis.\n\n\nRESULTS\nThe device success rate was 95.5%. Transoesophageal echocardiography-guided deployment demonstrated a low rate of procedure-related complications: 9.5% of acute kidney injury, 8% postoperative bleeding, 6% low-cardiac output, 4.5% postprocedural aortic regurgitation ≥+2, 4% implantation of permanent pacemaker and 2% stroke. There were no significant differences between preoperative and on discharge estimated glomerular filtration rate (53.9\u2009±\u200922.2 vs 54.3\u2009±\u200922.9\u2009ml/min/1.73 m2, P\u2009=\u20090.60). Logistic regression analysis confirmed postoperative bleeding as an independent predictor for acute kidney injury (odds ratio (OR) 11.148, 95% confidence interval 3.537-35.140, P\u2009<\u20090.001). In-hospital mortality was 7.5%. The mean follow-up was 48.5\u2009±\u200939.9\u2009months. Renal function and patient s chronic kidney disease stage did not significantly vary during follow-up. Long-term cumulative survival at 1, 5 and 10\u2009years was 84.2\u2009±\u20090.027%, 42.9\u2009±\u20090.038% and 32.5\u2009±\u20090.044%, respectively. Renal function affected on neither in-hospital mortality nor long-term survival.\n\n\nCONCLUSIONS\nNon-contrast, transoesophageal echocardiography-guided TA TAVR is a safe and reproducible technique with a low incidence of periprocedural complications that avoids the use of contrast and mitigates the incidence of acute kidney injury.