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      Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A Scientific Statement From the American Heart Association

      , , , , , , , , , , on behalf of the American Heart Association Council on the Kidney in Cardiovascular Disease and Stroke Council
      Circulation
      Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          Aortic stenosis with concomitant chronic kidney disease (CKD) represents a clinical challenge. Aortic stenosis is more prevalent and progresses more rapidly and unpredictably in CKD, and the presence of CKD is associated with worse short-term and long-term outcomes after aortic valve replacement. Because patients with advanced CKD and end-stage kidney disease have been excluded from randomized trials, clinicians need to make complex management decisions in this population that are based on retrospective and observational evidence. This statement summarizes the epidemiological and pathophysiological characteristics of aortic stenosis in the context of CKD, evaluates the nuances and prognostic information provided by noninvasive cardiovascular imaging with echocardiography and advanced imaging techniques, and outlines the special risks in this population. Furthermore, this statement provides a critical review of the existing literature pertaining to clinical outcomes of surgical versus transcatheter aortic valve replacement in this high-risk population to help guide clinical decision making in the choice of aortic valve replacement and specific prosthesis. Finally, this statement provides an approach to the perioperative management of these patients, with special attention to a multidisciplinary heart-kidney collaborative team-based approach.

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          Most cited references201

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          KDIGO Clinical Practice Guidelines for Acute Kidney Injury

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            2017 ESC/EACTS Guidelines for the management of valvular heart disease.

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              Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients

              Among patients with aortic stenosis who are at intermediate or high risk for death with surgery, major outcomes are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. There is insufficient evidence regarding the comparison of the two procedures in patients who are at low risk.
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                Author and article information

                Journal
                Circulation
                Circulation
                Ovid Technologies (Wolters Kluwer Health)
                0009-7322
                1524-4539
                June 22 2021
                June 22 2021
                : 143
                : 25
                Article
                10.1161/CIR.0000000000000979
                33980041
                555016b4-4526-4fe6-b152-f0447930a9eb
                © 2021
                History

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