Impact of Chronic Kidney Disease on Decision Making and Management in Transcatheter Aortic Valve Interventions

Can J Cardiol. 2019 Sep;35(9):1188-1194. doi: 10.1016/j.cjca.2018.11.010. Epub 2018 Nov 24.

Abstract

The coexistence of chronic kidney disease (CKD) and severe aortic stenosis (AS) is common, and the prevalence of both is rising. The 2 conditions are inherently linked in that significant CKD may accelerate the development of AS and severe AS may result in deteriorating kidney function. The volume of and indications for transcatheter aortic valve implantation (TAVI) procedures are ever-increasing, and there are many challenges that need to be considered in patients with concomitant severe AS and CKD being assessed for TAVI. Throughout the process of working these patients up for definitive management of their valvular heart disease, the presence of CKD impacts on diagnostic investigations, treatment decisions, and therapeutic interventions. Herein we review the current literature regarding TAVI in patients with CKD focusing on the decision-making process and specific risks involved in TAVI and CKD. We also provide specific practical strategies to best manage this challenging patient cohort.

Publication types

  • Review

MeSH terms

  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / complications
  • Aortic Valve Stenosis / surgery*
  • Decision Making*
  • Heart Valve Prosthesis*
  • Humans
  • Practice Guidelines as Topic*
  • Renal Insufficiency, Chronic / complications*
  • Risk Factors
  • Transcatheter Aortic Valve Replacement / methods*