J Lipid Atheroscler.  2018 Jun;7(1):62-67. 10.12997/jla.2018.7.1.62.

Contrast-free (Zero-contrast) TAVR for Severe Aortic Stenosis in Patient with Chronic Kidney Disease

• Choi YJ
• Ahn CM
• Kim DR
• Hong GR
• Ko YG
• Hong MK

• KMID: 2416259
• DOI: http://doi.org/10.12997/jla.2018.7.1.62

Abstract

Transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is a minimally invasive interventional procedure that repairs a valve without removing the old, damaged valve. Instead, a replacement valve is wedged into the location of the native aortic valve. During TAVR, contrast is used for conventional aortic root angiography, positioning of the TAVR valve device, and assessing the peripheral vasculature. Therefore, contrast-induced acute kidney injury (AKI) is a major concern when performing TAVR and is associated with increased mortality in patients with impaired renal function. Although the exact mechanism of post-TAVR AKI is unknown and appears multifactorial, contrast medium has been reported as a major contributing factor. We report a case of zero-contrast TAVR for severe AS in a patient with chronic kidney disease (CKD). The procedure was successfully performed with only fluoroscopic and transesophageal echocardiography (TEE) guidance.

Keyword

Transcatheter aortic valve replacement; Acute kidney injury; Chronic kidney diseases; Aortic stenosis

MeSH Terms

Acute Kidney Injury
Angiography
Aortic Valve
Aortic Valve Stenosis*
Echocardiography, Transesophageal
Humans
Mortality
Renal Insufficiency, Chronic*
Transcatheter Aortic Valve Replacement

Figure

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  Fig. 1 Transthoracic echocardiogram showed severe AS (AVA: 0.96 cm2 by continuity equation) with peak/mean pressure gradient (64/33 mmHg). AS; aortic stenosis, AVA; aortic valve area, BP; blood pressure.

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  Fig. 2 Annulus dimension and perimeter derived diameter by 3-dimentional echocardiogram.

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  Fig. 3 Location of catheter was identified by using biplane TEE (dotted circle indicated tip of catheter and asterisk indicated catheter). TEE; transesophageal echocardiography, PAT; patient, T; temperature.

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  Fig. 4 Vascular ultrasound showed acceptable access site of left external iliac artery. CFA; common femoral artery, SFA; superficial femoral artery, DFA; deep femoral artery.

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  Fig. 5 3D-echo in pre-evaluation and TEE during TAVR. TEE; transesophageal echocardiography, TAVR; transcatheter aortic valve replacement, Comm; commissure.

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