Importance of Femoral Access Method in Predicting the Development of Contrast Induced Nephropathy after Transfemoral Transcatheter Aortic Valve Implantation
İlker Gül, Mustafa Zungur, Ahmet Taştan, Muhammed Esad Çeki̇n, Ahmet Çağrı Aykan, Aysel İslamlı, Talat Tavlı
Keywords: Contrast induced nephropathy, transcatheter aortic valve implantation, femoral artery, vascular closure device, surgical cut-down
Introduction: Transcatheter aortic valve implantation (TAVI) is more reliable than surgical valve replacement for high-risk or inoperable aortic stenosis patients. In this study, we aimed to investigate the effects of different femoral access methods on the development of vascular complications and contrast-induced nephropathy (CIN) after transfemoral (TF)-TAVI. Patients and Methods: In total, 110 patients (aged 78.9 ± 12.2 years; 55 females) who underwent aortic valve replacement by TF-TAVI between June 2013 and April 2015 were included in the study. CIN was defined as an absolute increase in serum creatinine level of > 0.5 mg/dL or a relative increase of > 25% within 48-72 h after TF-TAVI. The patients were classified into two groups according to the femoral access methods: surgical cut-down (SCD) and vascular closure device (VCD) groups. Results: The amount of contrast medium (CM; p< 0.001) and the incidence of CIN (p= 0.038) were higher in the VCD group. Baseline glomerular filtration rate (GFR), baseline creatinine, Mehran score and CM were determined as the predictive factors of CIN development. Receiver operating characteristic analysis revealed that CM, which may predict the development of CIN, was determined as 178.5 mL, and GFR, which may predict the development of CIN, was determined as 48.9 mL/dk/1.73 m2. Conclusion: It may be preferred to perform the femoral arterial procedure using the SCD method instead of VCD in TAVI patients whose GFR is < 48.9; the use of CM may increase due to various reasons.