The impact of subclinical congestion on the outcome of patients undergoing transcatheter aortic valve implantation.

BACKGROUND: We investigated the impact of an elevated plasma volume status (PVS) in patients undergoing TAVI on early clinical safety and mortality, and assessed the prognostic utility of PVS for outcome prediction. MATERIALS AND METHODS: We retrospectively calculated the PVS in 652 patients undergoing TAVI between 2009 and 2018 at two centers. They were then categorized into two groups depending on their preoperative PVS (PVS -4; n=379). Relative PVS was derived by subtracting calculated ideal (iPVS = c x weight) from actual plasma volume (aPVS = (1-hematocrit) x (a +( b x weight in kg)). RESULTS: The need for renal replacement therapy (1 (0.4%) vs. 17 (4.5%); p=0.001), re-operation for non-cardiac reasons (9 (3.5%) vs. 32 (8.4%); p= 0.003), re-operation for bleeding (9 (3.5%) vs. 27 (7.1%); p= 0.037) and major bleeding (14 (5.4%) vs. 37 (9.8%); p=0.033) were significantly higher in patients with a PVS >-4%. The composite 30-day early safety endpoint (234 (91.1%) vs. 314 (82.8%); p=0.002) confirms that an increased preoperative PVS is associated with a worse overall outcome after TAVI. CONCLUSIONS: An elevated PVS (