Prognostic Impact of Residual Renal Congestion at Discharge After Transcatheter Aortic Valve Implantation

Background: Residual pulmonary congestion after transcatheter aortic valve implantation (TAVI) has been linked to adverse outcomes.However, whether renal congestion, assessed by intrarenal venous flow (IRVF), is associated with outcomes remains unclear.Methods: This study enrolled 164 patients with aortic stenosis who underwent TAVI and assessed IRVF before TAVI and at discharge (48-72 hours before discharge).The IRVF patterns were categorized as continuous (non-congestive) or discontinuous (congestive).The primary endpoint was a composite of allcause death or heart failure (HF) rehospitalization.Results: Before TAVI, 126 patients (76.8%) had a continuous pattern and 38 (23.2%) had a discontinuous pattern; at discharge, the numbers were 134 (81.7%) and 30 (18.3%), respectively.Over a median followup of 698 days, the primary endpoint occurred in 37 patients (22.6%).A discontinuous pattern at discharge was associated with a higher incidence of events than a continuous pattern (log-rank P = 0.005), whereas the pre-TAVI IRVF pattern did not stratify risk.In an analysis of changes in IRVF patterns (continuouscontinuous, continuous-discontinuous, discontinuous-continuous, and discontinuous-discontinuous), event rates were 20/114 (17.5%), 5/12 (41.7%), 4/20 (20.0%), and 8/18 (44.4%), respectively, and the risk was higher in patients discharged with a discontinuous pattern-continuous-discontinuous (hazard ratio HR, 3.26; 95% confidence interval CI, 1.19-8.92;P = 0.022) and discontinuous-discontinuous (HR, 2.34; 95% CI, 1.08-5.37;P = 0.045)-compared with those in the continuous-continuous group. Conclusions: A discontinuous IRVF pattern at discharge, indicating residual renal congestion after TAVI, J o u r n a l P r e -p r o o f was associated with adverse prognosis.