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.
Résumé
La coexistence de la maladie rénale chronique (MRC) et de la sténose aortique (SA)
est fréquente, et la prévalence de ces 2 maladies augmente. Les 2 maladies sont intrinsèquement
liées, en ce sens qu’une MRC importante peut accélérer le développement de la SA,
et qu’une SA grave peut entraîner la détérioration de la fonction rénale. Le nombre
d’interventions de remplacement valvulaire aortique par cathéter (TAVI) et leurs indications
ne cessent d’augmenter, mais de nombreux enjeux doivent être considérés chez les patients
qui sont atteints de façon concomitante de SA grave et de MRC et qui sont évalués
pour subir une intervention TAVI. Durant tout le processus du bilan de santé pour
la prise en charge définitive de la valvulopathie des patients, la présence de la
MRC a des répercussions sur les examens diagnostiques, les décisions de traitements
et les interventions thérapeutiques. Dans le présent article, nous passons en revue
la littérature actuelle sur le TAVI chez les patients atteints de MRC, et nous nous
penchons sur le processus décisionnel et les risques particuliers inhérents au TAVI
et à la MRC. Nous proposons également des stratégies pratiques particulières pour
mieux prendre en charge cette cohorte de patients complexes.
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Article info
Publication history
Published online: November 23, 2018
Accepted:
November 20,
2018
Received:
October 17,
2018
Footnotes
See page 1192 for disclosure information.
Identification
Copyright
Crown Copyright © 2018 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society. All rights reserved.
