Background Candidates for transcatheter aortic valve implantation (TAVI) are currently evaluated using computed tomography angiography and invasive cardiac catheterization as an essential part of case selection and pre-procedure interventional planning. However, both imaging methods utilize iodinated agents, which may cause contrast-induced nephropathy, particularly in patients with baseline renal dysfunction. This study aimed to describe a zero-contrast imaging protocol for pre-TAVI evaluation in patients with advanced renal impairment. Methods The pre-TAVI zero-contrast scheme consisted of the following multi-modality combinations: (1) gadolinium-free magnetic resonance imaging (three-dimensional navigator-echo with electrocardiogram-gated steady-state free-precession series); (2) iodinated-free multislice computed tomography electrocardiogram-gated; (3) lower limb arterial duplex scan ultrasound; and (4) transesophageal echocardiography. Ultimately, TAVI was performed for those deemed good candidates, and contrast was allowed during the intervention; however, operators were strongly advised to utilize the least volume possible of iodinated agents. This pilot survey included ten patients with symptomatic aortic stenosis and renal dysfunction who underwent zero-contrast multi-modality imaging. Results All the patients ultimately underwent TAVI. The intervention was successful in all cases, without >= moderate residual aortic regurgitation, prosthesis embolization, annulus rupture, major vascular complications, stroke, or death during index hospitalization. The creatinine clearance remained stable throughout the observation period (baseline: 26.85 +/- 12.55 mL/min; after multi-modality imaging: 26.76 +/- 11.51 mL/min; post-TAVI at discharge: 29.84 +/- 13.98 mL/min; p = 0.3 all). Conclusion The proposed contrast-free imaging protocol appears to be a promising clinical tool for pre-TAVI evaluation in patients with severe renal dysfunction.
Zero-contrast imaging for the assessment of transcatheter aortic valve implantation in candidates with renal dysfunction / Prado, Guy F. A.; Garzon, Stefano; Mariani, Jose; Caixeta, Adriano; O. Almeida, Breno; O. Ramalho, Felipe; C. Vieira, Marcelo L.; Fischer, Claudio H.; Szarf, Gilberto; Ishikawa, Walther; Lemos, Pedro A.. - In: RENAL FAILURE. - ISSN 0886-022X. - 45:1(2023). [10.1080/0886022x.2023.2224888]
Zero-contrast imaging for the assessment of transcatheter aortic valve implantation in candidates with renal dysfunction
Prado, Guy F. A.Primo
;
2023
Abstract
Background Candidates for transcatheter aortic valve implantation (TAVI) are currently evaluated using computed tomography angiography and invasive cardiac catheterization as an essential part of case selection and pre-procedure interventional planning. However, both imaging methods utilize iodinated agents, which may cause contrast-induced nephropathy, particularly in patients with baseline renal dysfunction. This study aimed to describe a zero-contrast imaging protocol for pre-TAVI evaluation in patients with advanced renal impairment. Methods The pre-TAVI zero-contrast scheme consisted of the following multi-modality combinations: (1) gadolinium-free magnetic resonance imaging (three-dimensional navigator-echo with electrocardiogram-gated steady-state free-precession series); (2) iodinated-free multislice computed tomography electrocardiogram-gated; (3) lower limb arterial duplex scan ultrasound; and (4) transesophageal echocardiography. Ultimately, TAVI was performed for those deemed good candidates, and contrast was allowed during the intervention; however, operators were strongly advised to utilize the least volume possible of iodinated agents. This pilot survey included ten patients with symptomatic aortic stenosis and renal dysfunction who underwent zero-contrast multi-modality imaging. Results All the patients ultimately underwent TAVI. The intervention was successful in all cases, without >= moderate residual aortic regurgitation, prosthesis embolization, annulus rupture, major vascular complications, stroke, or death during index hospitalization. The creatinine clearance remained stable throughout the observation period (baseline: 26.85 +/- 12.55 mL/min; after multi-modality imaging: 26.76 +/- 11.51 mL/min; post-TAVI at discharge: 29.84 +/- 13.98 mL/min; p = 0.3 all). Conclusion The proposed contrast-free imaging protocol appears to be a promising clinical tool for pre-TAVI evaluation in patients with severe renal dysfunction.File | Dimensione | Formato | |
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