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Transcatheter aortic-valve implantation with one single minimal contrast media injection


Arrigo, Mattia; Maisano, Francesco; Haueis, Sabine; Binder, Ronald K; Taramasso, Maurizio; Nietlispach, Fabian (2015). Transcatheter aortic-valve implantation with one single minimal contrast media injection. Catheterization and Cardiovascular Interventions, 85(7):1248-1253.

Abstract

Objectives: Performing transcatheter aortic valve implantation (TAVI) with the use of minimal contrast in patients at high-risk for acute kidney injury Background: Contrast-induced nephropathy is a major cause of acute kidney injury following TAVI and is associated with increased morbidity and mortality. The amount of contrast media used increases the risk for contrast-induced nephropathy. Methods: Computed tomography was omitted during the screening process. For the procedure transfemoral access was default. The self-expanding CoreValve prosthesis was chosen in all patients to minimize the risk of annular rupture in case of oversizing. Valve sizing was based on echocardiography, aortography, calcification on fluoroscopy, as well as weight and height of the patient. A single contrast injection was performed to confirm correct position of the pigtail catheter at the level of the annulus. The pigtail then served as the marker for the device landing zone. Intraprocedural assessment of the implantation result relied on echocardiography and hemodynamics. Results: Five patients with severe aortic stenosis and at high risk for developing contrast-induced nephropathy were included. Device success was achieved in all patients and no major complications occurred. The median dose of injected contrast media was 8ml (4-9). All but one patients had improved renal function after the intervention compared to baseline. Conclusions: Our study shows feasibility of performing TAVI with a single minimal contrast media injection, using a self-expandable valve. This technique has the potential to reduce the incidence of contrast-induced nephropathy. This article is protected by copyright. All rights reserved.

Abstract

Objectives: Performing transcatheter aortic valve implantation (TAVI) with the use of minimal contrast in patients at high-risk for acute kidney injury Background: Contrast-induced nephropathy is a major cause of acute kidney injury following TAVI and is associated with increased morbidity and mortality. The amount of contrast media used increases the risk for contrast-induced nephropathy. Methods: Computed tomography was omitted during the screening process. For the procedure transfemoral access was default. The self-expanding CoreValve prosthesis was chosen in all patients to minimize the risk of annular rupture in case of oversizing. Valve sizing was based on echocardiography, aortography, calcification on fluoroscopy, as well as weight and height of the patient. A single contrast injection was performed to confirm correct position of the pigtail catheter at the level of the annulus. The pigtail then served as the marker for the device landing zone. Intraprocedural assessment of the implantation result relied on echocardiography and hemodynamics. Results: Five patients with severe aortic stenosis and at high risk for developing contrast-induced nephropathy were included. Device success was achieved in all patients and no major complications occurred. The median dose of injected contrast media was 8ml (4-9). All but one patients had improved renal function after the intervention compared to baseline. Conclusions: Our study shows feasibility of performing TAVI with a single minimal contrast media injection, using a self-expandable valve. This technique has the potential to reduce the incidence of contrast-induced nephropathy. This article is protected by copyright. All rights reserved.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Date:2015
Deposited On:22 Jan 2015 16:09
Last Modified:05 Apr 2016 18:55
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1522-1946
Publisher DOI:https://doi.org/10.1002/ccd.25799
PubMed ID:25545281

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