Erika Muñoz-García

Clinical impact of acute kidney injury on short- and long-term outcomes after transcatheter aortic valve implantation with the CoreValve prosthesis

BACKGROUND Acute kidney injury (AKI) after cardiac surgery is associated with increased mortality, but few data exist on the occurrence and clinical impact of AKI associated with transcatheter aortic valve implantation (TAVI). The objective of this study was to determine the incidence and prognosis of AKI after percutaneous implantation of the CoreValve(®) (Medtronic, Minneapolis, MN, USA) prosthesis. METHODS A total of 357 patients with severe aortic stenosis and 9 patients with pure native aortic regurgitation were treated with the CoreValve prosthesis. AKI was defined according to Valve Academic Research Consortium criteria as the absolute increase in serum creatinine ≥0.3mg/dl at 72h post percutaneous procedure. RESULTS AKI was identified in 58 patients (15.8%), none of whom required renal replacement therapy. In patients with AKI, the mortality at 30 days was 13.5% compared with 1.6% of patients without AKI, [odds ratio (OR)=12.2 (95% CI 3.53-41.9); p<0.001] and total mortality after a mean of 26.2±17 months was 29.3% vs. 14.9% [OR=2.36 (95% CI 1.23-4.51), p=0.008]. In the multivariate analysis, AKI was an independent predictor of cumulative total mortality [hazard ratio=2.151, (95% CI from 1.169 to 3.957), p=0.014]. CONCLUSIONS The deterioration of renal function in patients undergoing TAVI with the CoreValve prosthesis is a serious and frequent complication. The occurrence of AKI was associated with increased early mortality and was also a predictor of worse outcomes in follow-up.

Trastornos de la conducción auriculoventricular tras el implante valvular aórtico transcatéter

Resumen El implante valvular aortico transcateter ha supuesto una revolucion en el campo del intervencionismo, con unos resultados excelentes, pero no esta exento de complicaciones. Las alteraciones de la conduccion auriculoventricular son las mas prevalentes, fundamentalmente el bloqueo de rama izquierda del haz de His, por la proximidad del nodulo auriculoventricular y el haz de His a la valvula aortica. El tipo de valvula percutanea influye en la incidencia de trastornos de conduccion y la posterior necesidad de marcapasos. Un implante de marcapasos supone un empeoramiento de la funcion ventricular en el seguimiento, pero parece que no afecta a la mortalidad. La posicion de la protesis es uno de los principales factores de la necesidad de marcapasos, y los nuevos disenos permitiran un implante mas controlado y un mejor posicionamiento, pero no llegaran a excluir el riesgo de bloqueo auriculoventricular completo. Conocer mejor esta complicacion permitira disminuir el grado de incertidumbre que puedan suponer los bloqueos auriculoventriculares paroxisticos y sus consecuencias clinicas.