Introduction: The aim of the study was to investigate prevalence and impact of incidental renal masses (IRMs) accompanying increasing computed tomography (CT) work-up for symptomatic aortic valve stenosis (sAVS) of the elderly with regard to the relevance of urological consultation for overall survival (OS). Methods: A retrospective analysis of pre-transcatheter aortic-valve implantations (TAVIs) CT scans of patients with sAVS (N = 1,253) harboring IRM was performed for 2014–2019. According to the clinical management, groups 1 (urologic consultation) and 2 (findings ignored) were formed and analyzed in terms of OS. Results: The prevalence of IRM was 9% (119/1,253). In 19% (23/119), urological advice was sought (group 1). At baseline, group 1 showed a significantly higher rate of malignancy-specific lesions compared to 2 (p < 0.01). Other clinical parameters (e.g., age, cardiological scores, comorbidities) did not differ between groups (p > 0.05). In group 1, 4 (17%) findings were histologically confirmed, of which 3 (13%) underwent surgery. There was no significant difference in median OS at a median follow-up of 24.7 months between groups 1 and 2 with 35.7 (95% CI, 5.9; 65.4) and 47.4 months (95% CI, 33.0; 61.7), respectively (p = 0.4). In Cox regression analysis, chronic kidney disease but not urologic work-up or chronic obstructive pulmonary disease or heart failure emerged as an independent unfavorable predictor of OS (HR 2.44, 95% CI 1.37; 4.36, p = 0.003). Conclusion: For the first time, a TAVI population with IRM was analyzed from the urologist’s perspective. Urologic co-evaluation and work-up does not confer a significant benefit in terms of OS in this particular population.

1.
UK TAVI Trial Investigators
;
Toff
WD
,
Hildick-Smith
D
,
Kovac
J
,
Mullen
MJ
,
Wendler
O
, et al
.
Effect of transcatheter aortic valve implantation vs surgical aortic valve replacement on all-cause mortality in patients with aortic stenosis: a randomized clinical trial
.
JAMA
.
2022
;
327
(
19
):
1875
87
. .
2.
Vahanian
A
,
Beyersdorf
F
,
Praz
F
,
Milojevic
M
,
Baldus
S
,
Bauersachs
J
, et al
.
2021 esc/eacts guidelines for the management of valvular heart disease
.
Eur Heart J
.
2022
;
43
(
7
):
561
632
. .
3.
Kapadia
SR
,
Leon
MB
,
Makkar
RR
,
Tuzcu
EM
,
Svensson
LG
,
Kodali
S
, et al
.
5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (partner 1): a randomised controlled trial
.
Lancet
.
2015
;
385
(
9986
):
2485
91
. .
4.
van Kesteren
F
,
Wiegerinck
EMA
,
van Mourik
MS
,
Vis
MM
,
Koch
KT
,
Piek
JJ
, et al
.
Impact of potentially malignant incidental findings by computed tomographic angiography on long-term survival after transcatheter aortic valve implantation
.
Am J Cardiol
.
2017
;
120
(
6
):
994
1001
. .
5.
Bosniak
MA
.
How does one deal with a renal cyst that appears to be bosniak class ii on a ct scan but that has sonographic features suggestive of malignancy (e.G., nodularity of wall or a nodular, irregular septum)
.
AJR Am J Roentgenol
.
1994
;
163
(
1
):
216
. .
6.
Ackermann
H
.
Bias: a program package for biometrical analysis of samples
.
Comput Stat Data Anal
.
1991
;
11
(
2
):
223
4
. .
7.
Ko
K
,
Zwetsloot
PP
,
Voskuil
M
,
Stella
P
,
Leiner
T
,
Kraaijeveld
A
.
Clinically significant incidental findings on ct imaging during tavi work-up: a systematic review and meta-analysis
.
J Invasive Cardiol
.
2022
;
34
(
3
):
E218
25
.
8.
Hinton
J
,
Gough
S
,
Ahmed
H
,
Gabara
L
,
Rawlins
J
,
Calver
A
, et al
.
Frequency and impact of incidental findings on computed tomography during work-up for transcatheter aortic valve implantation: single centre experience and review of the literature
.
Br J Radiol
.
2019
;
92
(
1102
):
20190344
. .
9.
Morgan
L
,
Choi
H
,
Reid
M
,
Khawaja
A
,
Mazzone
PJ
.
Frequency of incidental findings and subsequent evaluation in low-dose computed tomographic scans for lung cancer screening
.
Ann Am Thorac Soc
.
2017
;
14
(
9
):
1450
6
. .
10.
Heide
J
,
Ribback
S
,
Klatte
T
,
Shariat
S
,
Burchardt
M
,
Dombrowski
F
, et al
.
Evaluation of the prognostic role of co-morbidities on disease outcome in renal cell carcinoma patients
.
World J Urol
.
2020
;
38
(
6
):
1525
33
. .
11.
Osmanska
J
,
Murdoch
D
.
Real-life outcomes and readmissions after a tavi procedure in a Glasgow population
.
Br J Cardiol
.
2021
;
28
(
3
):
37
. .
12.
Charlson
ME
,
Pompei
P
,
Ales
KL
,
MacKenzie
CR
.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
.
J Chronic Dis
.
1987
;
40
(
5
):
373
83
. .
13.
Hoyert
DL
,
Xu
J
.
Deaths: preliminary data for 2011
.
Natl Vital Stat Rep
.
2012
;
61
(
6
):
1
51
.
14.
Mas-Peiro
S
,
Faerber
G
,
Bon
D
,
Herrmann
E
,
Bauer
T
,
Bleiziffer
S
, et al
.
Impact of chronic kidney disease in 29,893 patients undergoing transcatheter or surgical aortic valve replacement from the German aortic valve registry
.
Eur J Cardiothorac Surg
.
2021
;
59
(
3
):
532
44
. .
15.
Yamamoto
M
,
Hayashida
K
,
Mouillet
G
,
Hovasse
T
,
Chevalier
B
,
Oguri
A
, et al
.
Prognostic value of chronic kidney disease after transcatheter aortic valve implantation
.
J Am Coll Cardiol
.
2013
;
62
(
10
):
869
77
. .
16.
Shuch
B
,
Hanley
JM
,
Lai
JC
,
Vourganti
S
,
Setodji
CM
,
Dick
AW
, et al
.
Adverse health outcomes associated with surgical management of the small renal mass
.
J Urol
.
2014
;
191
(
2
):
301
8
. .
17.
Smaldone
MC
,
Kutikov
A
,
Egleston
BL
,
Canter
DJ
,
Viterbo
R
,
Chen
DY
, et al
.
Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis
.
Cancer
.
2012
;
118
(
4
):
997
1006
. .
18.
Pierorazio
PM
,
Johnson
MH
,
Ball
MW
,
Gorin
MA
,
Trock
BJ
,
Chang
P
, et al
.
Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the dissrm registry
.
Eur Urol
.
2015
;
68
(
3
):
408
15
. .
19.
Lee
ZX
,
Elangovan
S
,
Anderson
R
,
Groves
P
.
Short- and medium-term survival after tavi: clinical predictors and the role of the France-2 score
.
Int J Cardiol Heart Vasc
.
2020
;
31
:
100657
. .
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