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Cardiovascular Medicine
Volume 22
Issue 1
10.4414/cvm.2019.02021
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Cardiovascular Medicine is published by MDPI from Volume 28 Issue 1 (2025). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Editores Medicorum Helveticorum (EMH).
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Article

Minimal Use of Contrast Media in Patients with Severe Chronic Kidney Disease Undergoing Transcatheter Aortic Valve Implantation

by
Brinkert Miriam
1,
de Boeck Bart
1,2,
Petryka Joanna
3,
Buhmann Ralf
2,
Fornaro Jürgen
2,
Weberndörfer Vanessa
1,
Bossard Matthias
1,
Roos Justus
2,
Cuculi Florim
1,
Kobza Richard
1 and
Toggweiler Stefan
1,*
1
Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
2
Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
3
Department of Coronary Artery Disease and Structural Heart Disease, Magnetic Resonance Unit, the National Institute of Cardiology,Warsaw, Poland
*
Author to whom correspondence should be addressed.
Cardiovasc. Med. 2019, 22(1), w02021; https://doi.org/10.4414/cvm.2019.02021
Submission received: 26 November 2018 / Revised: 26 December 2018 / Accepted: 26 January 2019 / Published: 26 February 2019
Versions Notes

Abstract

Background: Patients with severe kidney disease and severe aortic stenosis requiring transcatheter aortic valve implantation (TAVI) represent a growing cohort. In this context, we investigated the feasibility and safety of a novel integrated approach, including gadolinium-free magnetic resonance tomography (MR) in order to minimize use of any contrast media (CM) in those patients. Methods and results: Out of a cohort of 168 patients undergoing TAVI, 20 (12%) patients with severe chronic kidney disease (CKD) were managed by applying an integrated approach using minimal dosage of CM. Coronary angiographies were performed with 54±35ml and 85±44ml of CM in patients with severe CKD and patients without severe CKD, respectively (p <0.01). In patients with severe CKD, gadolinium-free magnetic resonance tomographies (MR) were performed for annular and iliofemoral assessment. All other patients were screened with ECGgated multislice computed tomography using 63±14ml of CM. In patients with severe versus without severe CKD, TAVIs were performed with 40± 32ml versus 112±50 ml of contrast media, respectively (p <0.01). During followup, stage 2 or 3 acute kidney injury (AKI) occurred in 1 (5%) versus 4 (2.8%, p = 0.05). At 30 days, there were no strokes, and survival was 100% and 98%, respectively. Conclusions: We were able to reduce the total amount of CM required for pre-procedural planning and TAVI by 64% from 260 ± 79 ml to 94 ± 54 ml. This study indicates that gadolinium-free MR can be used for pre-procedural annular and iliofemoral assessment, and thus selection of prosthesis size.
Keywords: aortic stenosis; transcatheter aortic valve replacement; TAVI; renal failure; magnetic resonance tomography; contrast induced nephropathy aortic stenosis; transcatheter aortic valve replacement; TAVI; renal failure; magnetic resonance tomography; contrast induced nephropathy

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MDPI and ACS Style

Miriam, B.; Bart, d.B.; Joanna, P.; Ralf, B.; Jürgen, F.; Vanessa, W.; Matthias, B.; Justus, R.; Florim, C.; Richard, K.; et al. Minimal Use of Contrast Media in Patients with Severe Chronic Kidney Disease Undergoing Transcatheter Aortic Valve Implantation. Cardiovasc. Med. 2019, 22, w02021. https://doi.org/10.4414/cvm.2019.02021

AMA Style

Miriam B, Bart dB, Joanna P, Ralf B, Jürgen F, Vanessa W, Matthias B, Justus R, Florim C, Richard K, et al. Minimal Use of Contrast Media in Patients with Severe Chronic Kidney Disease Undergoing Transcatheter Aortic Valve Implantation. Cardiovascular Medicine. 2019; 22(1):w02021. https://doi.org/10.4414/cvm.2019.02021

Chicago/Turabian Style

Miriam, Brinkert, de Boeck Bart, Petryka Joanna, Buhmann Ralf, Fornaro Jürgen, Weberndörfer Vanessa, Bossard Matthias, Roos Justus, Cuculi Florim, Kobza Richard, and et al. 2019. "Minimal Use of Contrast Media in Patients with Severe Chronic Kidney Disease Undergoing Transcatheter Aortic Valve Implantation" Cardiovascular Medicine 22, no. 1: w02021. https://doi.org/10.4414/cvm.2019.02021

APA Style

Miriam, B., Bart, d. B., Joanna, P., Ralf, B., Jürgen, F., Vanessa, W., Matthias, B., Justus, R., Florim, C., Richard, K., & Stefan, T. (2019). Minimal Use of Contrast Media in Patients with Severe Chronic Kidney Disease Undergoing Transcatheter Aortic Valve Implantation. Cardiovascular Medicine, 22(1), w02021. https://doi.org/10.4414/cvm.2019.02021

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