Microcirculatory tissue oxygenation correlates with kidney function after transcatheter aortic valve implantation-Results from a prospective observational study

Maximilian Dietrich; Ana Antonovici; Tobias Hölle; Christian Nusshag; Anne-Christine Kapp; Alexander Studier-Fischer; Rawa Arif; Felix Nickel; Markus Alexander Weigand; Norbert Frey; Christoph Lichtenstern; Florian Leuschner; Dania Fischer

doi:10.3389/fcvm.2023.1108256

Microcirculatory tissue oxygenation correlates with kidney function after transcatheter aortic valve implantation-Results from a prospective observational study

Front Cardiovasc Med. 2023 Feb 14:10:1108256. doi: 10.3389/fcvm.2023.1108256. eCollection 2023.

Affiliations

¹ Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
² Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany.
³ Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
⁴ Institute of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany.
⁵ Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany.

Abstract

Introduction: Kidney dysfunction is common in patients with aortic stenosis (AS) and correction of the aortic valve by transcatheter aortic valve implantation (TAVI) often affects kidney function. This may be due to microcirculatory changes.

Methods: We evaluated skin microcirculation with a hyperspectral imaging (HSI) system, and compared tissue oxygenation (StO₂), near-infrared perfusion index (NIR), tissue hemoglobin index (THI) and tissue water index (TWI) in 40 patients undergoing TAVI versus 20 control patients. HSI parameters were measured before TAVI (t1), directly after TAVI (t2), and on postinterventional day 3 (t3). The primary outcome was the correlation of tissue oxygenation (StO₂) to the creatinine level after TAVI.

Results: We performed 116 HSI image recordings in patients undergoing TAVI for the treatment of severe aortic stenosis and 20 HSI image recordings in control patients. Patients with AS had a lower THI at the palm (p = 0.034) and a higher TWI at the fingertips (p = 0.003) in comparison to control patients. TAVI led to an increase of TWI, but had no uniform enduring effect on StO₂ and THI. Tissue oxygenation StO₂ at both measurement sites correlated negatively with creatinine levels after TAVI at t2 (palm: ρ = -0.415; p = 0.009; fingertip: ρ = -0.519; p < 0.001) and t3 (palm: ρ = -0.427; p = 0.008; fingertip: ρ = -0.398; p = 0.013). Patients with higher THI at t3 reported higher physical capacity and general health scores 120 days after TAVI.

Conclusion: HSI is a promising technique for periinterventional monitoring of tissue oxygenation and microcirculatory perfusion quality, which are related to kidney function, physical capacity, and clinical outcomes after TAVI.

Clinical trial registration: https://drks.de/search/de/trial, identifier DRKS00024765.

Keywords: TAVI–transcatheter aortic valve implantation; TAVR-transcatheter aortic valve replacement; cardiovascular interventions; hyperspectral imaging (HSI); kidney function; microcirculation; monitoring; risk assessment.

Grants and funding

This work was supported by a grant from the Medical Faculty of Heidelberg, by the German Heart Foundation, and Diaspective Vision through the provision of the TIVITAR^® (Grant number F/20/21) Tissue System. Diaspective Vision had no role in the design, execution, interpretation, or writing of the study.