Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement

Vincenzo Pasceri, Francesco Pelliccia, Roxana Mehran, George Dangas, Italo Porto, Francesco Radico, Fausto Biancari, Fabrizio D’ascenzo, Francesco Saia, Giampaolo Luzi, Francesco Bedogni, Ignacio J. Amat Santos, Vincenzo De Marzo, Arnaldo Dimagli, Timo Mäkikallio, Eugenio Stabile, Sara Blasco-Turrión, Luca Testa, Marco Barbanti, Corrado TamburinoFranco Fabiocchi, Ahmed Chilmeran, Federico Conrotto, Giuliano Costa, Giulio Stefanini, Carmen Spaccarotella, Andrea Macchione, Michele La Torre, Francesco Bendandi, Tatu Juvonen, Wojciech Wańha, Wojtek Wojakowski, Umberto Benedetto, Ciro Indolfi, David Hildick-Smith, Marco Zimarino

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Dialysis is a rare but serious complication after transcatheter aortic valve replacement. We analyzed the large multicenter TRITAVI (transfusion requirements in transcatheter aortic valve implantation) registry in order to develop and validate a clinical score assessing this risk. METHODS AND RESULTS: A total of 10 071 consecutive patients were enrolled in 19 European centers. Patients were randomly assigned (2:1) to a derivation and validation cohort. Two scores were developed, 1 including only preprocedural variables (TRITAVIpre) and 1 also including procedural variables (TRITAVIpost). In the 6714 patients of the derivation cohort (age 82±6 years, 48% men), preprocedural factors independently associated with dialysis and included in the TRITAVIpre score were male sex, diabetes, prior coronary artery bypass graft, anemia, nonfemoral access, and creatinine clearance <30 mL/ min per m2. Additional independent predictors among procedural features were volume of contrast, need for transfusion, and major vascular complications. Both scores showed a good discrimination power for identifying risk for dialysis with C-statistic 0.78 for TRITAVIpre and C-statistic 0.88 for TRITAVIpost score. Need for dialysis increased from the lowest to the highest of 3 risk score groups (from 0.3% to 3.9% for TRITAVIpre score and from 0.1% to 6.2% for TRITAVIpost score). Analysis of the 3357 patients of the validation cohort (age 82±7 years, 48% men) confirmed the good discrimination power of both scores (C-statistic 0.80 for TRITAVIpre and 0.81 for TRITAVIpost score). Need for dialysis was associated with a significant increase in 1-year mortality (from 6.9% to 54.4%; P=0.0001). CONCLUSIONS: A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement.

Original languageEnglish
Article numbere032955
JournalJournal of the American Heart Association
Volume13
Issue number7
DOIs
StatePublished - 2 Apr 2024

Keywords

  • acute kidney injury
  • dialysis
  • mortality
  • risk score
  • transcatheter aortic valve replacement

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