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Improvement in renal functions with transcatheter aortic valve implantation

Journal of Geriatric Cardiology 2013年第4期10卷 317-322页

作者： Telat Keleş Huseyin Ayhan Durmaz Sarı Aslan AN Erdoğan KE kasapkara Bilen Bayram Akçay Bozkurt Department of Cardiology Yıldırım Beyazıt University Bilkent 06800 Ankara Turkey Department of Cardiology Ankara Ataturk Education and Research Hospital Bilkent 06800 Ankara Turkey Department of Cardiovascular Surgery Ankara Ataturk Education and Research Hospital Bilkent 06800 Ankara Turkey.

BACKGROUND & OBJECTIVES:In recent years, emerging transcatheter aortic valve implantation (TAVI) has become an alternative for surgery。 However, with advanced age, several co-morbid factors together with contrast agent usage can cause deterioration in renal function and increase in the risk of acute kidney injury (AKI) with poor prognosis in patients with AKI。 Therefore, many patients cannot benefit from this treatment。 In this study, we aim to examine the effects of TAVI on renal functions。 METHODS AND RESULTS: Seventy patients, mean age of 77.6 years, underwent TAVI between July 2011 and December 2012。 Estimated glomerular filtration rate (eGFR) was calculated by using the Cockcroft and Gault Formula。 Patients were monitored for 48 h for urine output。 Stage 1 AKI, according to the VARC-2 AKIN system, developed in only five (7.1%) of the patients after the procedure。 There was a statistically significant increase between the mean 1(st) month eGFRs before (68。2 vs。 61.0, P < 0.01) and after (68。2 vs。 63.6, P < 0.05) the TAVI in the cohort。 After TAVI (48。5 mL/min, P < 0.01) and the 1(st) month (52.1 mL/min, P < 0.01), the eGFR of the 36 (51.4%) patients diagnosed with chronic kidney disease before the procedure showed a statistically significant increase in renal functions。 The hospital mortality rate was higher in the group which developed AKI (P < 0.01)。 First month eGFR showed a more statistically significant increase than pre-TAVI eGFR (62.8 and 69.8, P < 0.05, respectively) in AKI developing patients and this difference - though statistically not significant - continued into the sixth month。 CONCLUSIONS: In this study, we showed that the treatment of aortic stenosis through TAVI allows improvement of renal functions, and that AKI rates will be lower with careful patient selection, proper pre-procedural hydration, and careful use of contrast agent。

关键词： Improvement Kidney injury Transcatheter aortic valve implantation

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Evaluation of CA125 and NT-proBNP values in patients undergoing transcatheter aortic valve implantation

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Journal of Geriatric Cardiology 2015年第2期12卷 100-106页

作者： Huseyin Ayhan Haca Ahmet kasapkara Tahir Durmaz Telat Keles Cenk San Serdal Bastug Kemal Esref Erdogan Nihal Akar Bayram Emine Bilen Murat Akgay Engin Bozkurt Faculty of Medicine Department of Cardiology Ytldtrtm Beyaztt University Ankara 06800 Turkey Department of Cardiology Ankara Ataturk Education and Research Hospital Ankara 06800 Turkey Faculty of Medicine Department of Cardiovascular Surgery Yddtrtm Beyaztt University Ankara 06800 Turkey

Background Transcatheter aortic valve implantation （TAVI） is a minimally invasive, emerging therapy in surgically high risk, or in- operable patients. Parameters used for risk classification have some deficiencies in the selection of patients. The objective of this study is to evaluate the impact of TAVI on carbohydrate antigen 125 （CA125） and N-terminal pro brain-type natriuretic peptide （NT-proBNP） as biomarkers that have been used frequently in recent years, and also the relationship of these biomarkers to prognosis. Methods ＆ Results Transcatheter aortic valve implantation was practiced on 31 patients in this study. Then, CA125 and NT-proBNP levels studied in patients prior to and after the TAVI were evaluated. The patients were also grouped in accordance with their left ventrieular ejection fraction （LVEF） and CA125 levels （LVEF 〉 40% and 〈 40%; CA125 ≤ 35 U/L and 〉 35 U/L）. The TAVI operation was successfully performed in all patients. There was no in-hospital mortality and substantial improvement in functional capacity was detected at follow ups. In addition, a statistically significant decrease was detected in post-TAVI CA 125 and NT-proBNP levels of all patients （CA 125 83.8 ± 18.1 U/L vs. 64.3 ±14.2 U/L, P = 0.008; NT-proBNP： 4633.6± 627.6 pg/mL vs. 2866.3±536.8 pg/mL, P 〈 0.001）. In groups divided according to the CA125 levels, there was also statistically significant post-TAVI decline in CA125 levels. Within CA125 〉 35 U/L and LVEF 〈 40% groups, the permanent need for a pacemaker was required in one （3.2%） patient and mortality was observed in two （6.4%） patients after TAVI at follow up. Conclusions The results show that TAVI can be performed effectively and reliably in patients with high baseline levels of CA125 and NT-proBNP. These biomarkers are reduced substantially with TAVI, while high biomarker levels are associated with undesired events, and certainly, these biomarkers can be used for risk classifications in patient selection for TAVI.

关键词： B-type natriuretic peptide Biomarker Carbohydrate antigen Heart failure Transcatheter aortic valve implantation Risk score

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