Nerla Roberto, Mikus Elisa, Sanseviero Angela, Squeri Angelo, Calvi Simone, Savini Carlo, Sangiorgi Diego, Castriota Fausto
Interventional Cardiology Unit, GVM (Gruppo Villa Maria) Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy.
Cardiac Surgery Unit, GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy.
J Clin Med. 2024 Sep 12;13(18):5405. doi: 10.3390/jcm13185405.
: We aimed to compare the procedural efficacy and long-term clinical results of a totally contrast-free Transcatheter Aortic Valve Implantation (TAVI) procedure (i.e., contrast dye was not used for either the pre-procedural assessment or during the procedure) to those of standard practice in patients with severe renal dysfunction. : All consecutive patients with a glomerular filtration rate (GFR) ≤ 35 mL/min and severe aortic stenosis who were treated with transfemoral TAVI at our Institution were included in the registry. The zero-contrast patients underwent carbon dioxide angiography and a non-contrast CT scan for assessment of vascular access suitability, and aortic annulus sizing was performed by a TEE, and the procedural guidance was fluoroscopic and echocardiographic. Procedural outcomes were evaluated, and clinical long-term follow-up was performed for all included patients. : A total of 44 patients (median age, 85 (IQR, 80.75-87.00)) were included in the zero-contrast group (TEE guidance and general anesthesia in 37 (84%) patients), while 63 patients were included in the standard practice arm (82 ± 78 mL of contrast dye used). Procedural success was obtained in 100% of cases. There were no differences in procedural outcomes, including final mean aortic gradients (5.5 (IQR, 5.0-10.0) mmHg in the zero-contrast group vs. 6.0 (IQR, 5.0-10.0) mmHg in the standard practice group) and rate of at least a moderate paravalvular leak (0% vs. 1.6% in the zero-contrast and standard practice groups, respectively; = 0.31). No differences in AKI during the hospital stay were observed. Over a median follow-up of 3.3 years, there was a significantly lower rate of AKI (1.2% vs. 25.9%, < 0.001) and rehospitalizations (1.6% vs. 35.5%, < 0.00) in standard practice group. : We showed for the first time the feasibility and efficacy of a totally contrast-free strategy compared to standard practice in TAVI patients with severe renal dysfunction. Besides achieving comparable procedural results, the zero-contrast strategy showed a better long-term clinical outcome in reducing hospital readmissions for kidney function deterioration.
我们旨在比较完全无造影剂的经导管主动脉瓣植入术（TAVI）（即在术前评估或手术过程中均未使用造影剂）与标准治疗方法在严重肾功能不全患者中的手术疗效和长期临床结果。
所有在我们机构接受经股动脉TAVI治疗的连续肾小球滤过率（GFR）≤35 mL/min且患有严重主动脉瓣狭窄的患者均被纳入登记研究。无造影剂组患者接受二氧化碳血管造影和非增强CT扫描以评估血管入路的适宜性，并通过经食管超声心动图（TEE）测量主动脉瓣环大小，手术指导采用荧光透视和超声心动图。评估手术结果，并对所有纳入患者进行临床长期随访。
无造影剂组共纳入44例患者（中位年龄85岁（四分位间距，80.75 - 87.00岁）），其中37例（84%）患者采用TEE引导和全身麻醉，而标准治疗组纳入63例患者（使用造影剂82±78 mL）。所有病例手术均成功。手术结果无差异，包括最终平均主动脉跨瓣压差（无造影剂组为5.5（四分位间距，5.0 - 10.0）mmHg，标准治疗组为6.0（四分位间距，5.0 - 10.0）mmHg）以及至少中度瓣周漏发生率（无造影剂组与标准治疗组分别为0%和1.6%；P = 0.31）。住院期间急性肾损伤（AKI）无差异。在中位随访3.3年期间，标准治疗组的AKI发生率（1.2% vs. 25.9%，P < 0.001）和再住院率（1.6% vs. 35.5%，P < 0.00）显著更低。
我们首次证明了与标准治疗方法相比，完全无造影剂策略在严重肾功能不全的TAVI患者中的可行性和有效性。除了获得可比的手术结果外，无造影剂策略在减少因肾功能恶化导致的再次住院方面显示出更好的长期临床结果。
