Low Contrast Strategies in TAVR: Feasibility and Outcomes to Prevent Renal Injury in Chronic Kidney Disease

Abstract

Background

Contrast volume is a major risk factor for acute kidney injury (AKI) in patients with chronic kidney disease (CKD) after TAVR. Use of a low-contrast (LC) protocol in TAVR may reduce AKI without impacting other clinical outcomes.

Methods

TAVR patients with Stage 3b or worse CKD between 2015 and 2020 were grouped into LC and normal-contrast (NC). LC was defined as TAVR procedure contrast use (mL) less than estimated glomerular filtration rate (eGFR, mL/min/1.73 m²). The primary outcome was AKI, defined as creatinine elevation > 200% or ≥ 0.3 mg/dL from baseline. Secondary outcomes were 30-day mortality, length of stay, paravalvular leak at 30 days, new dialysis requirement, major vascular complication, re-admission, bleeding, and a composite primary endpoint of secondary outcomes. We performed a propensity-matched analysis, compared cohort outcomes, and stratified outcomes by AKI severity.

Results

Four hundred thirty-seven patients were analyzed. The LC group (n = 173) were more commonly male and had a lower baseline eGFR (31 vs. 33, p = 0.03) than the NC group (n = 264). After propensity-matching, AKI occurred less frequently in LC patients than in the NC patients (17.9 vs. 28.3%, p = 0.0217). There were no inter-group differences in mortality, new dialysis requirement, major vascular complications, bleeding, or re-admissions.

Conclusions

In TAVR patients with CKD, LC volume was associated with reduced risk of AKI, supporting a LC approach for TAVR in CKD patients.

Aims

We sought to evaluate the outcomes of a LC versus normal-contrast dose strategy in TAVR amongst patients with CKD.