High-flow nasal oxygen during transcatheter aortic valve implantation under sedation: one-year follow-up of the HIGH-OXY-TAVR randomised controlled trial
A Manzano, M Gimenez, M SabateAbstract
Background
High-flow nasal oxygen (HFNO) improves intraprocedural oxygenation during transcatheter aortic valve implantation (TAVI) under conscious sedation. Early results from the HIGH-OXY-TAVR randomized trial suggested improved postoperative renal function, but longterm effects remain uncertain. 1
Purpose
To assess one-year changes in renal and cardiac biomarkers and postoperative clinical outcomes following TAVI with HFNO versus standard oxygen therapy.
Methods
This predefined longitudinal follow-up included all 125 patients enrolled in the single-centre HIGH-OXY-TAVR RCT comparing HFNO (60 L/min, FiO₂ 60%) with low-flow oxygen (5 L/min) during TAVI. Serum creatinine, glomerular filtration rate (GFR), and NT-proBNP were evaluated at baseline, 1 month, and 1 year. Clinical outcomes included allcause mortality, stroke, heart failure rehospitalisation, acute kidney injury (AKI) defined according to VARC-2, and a composite major adverse events (MAE) endpoint.
Results
One year follow-up was complete for all patients (HFNO n=64; control n=61). Decline in GFR was significantly attenuated with HFNO at 1 month (−0.53 vs −3.93 mL/min/1.73m2 ; p<0.05) and 1 year (−1.0 vs −4.9 mL/min/1.73m2; p<0.05). Similarly, the median increase in serum creatinine was significantly lower with HFNO at 1 month [0.01 mg/dL (IQR −0.12 to 0.08) vs 0.09 mg/dL (IQR −0.05 to 0.21); p<0.05] and at 1 year [0.02 mg/dL (IQR −0.10 to 0.12) vs 0.095 mg/dL (IQR 0.02 to 0.22); p<0.05]. AKI incidence was lower with HFNO at 1 month (0% vs 14.8%; p<0.05) and numerically reduced at 1 year (7.8% vs 19.7%; p=0.053). NT-proBNP evolution was similar between groups. MAE occurred less frequently with HFNO at 1 month (7.8% vs 19.7%; p=0.053) and was significantly lower at 1 year (26.5% vs 44.3%; p<0.05). See table 1
Conclusions
During TAVI under sedation, HFNO was associated with sustained renal function preservation and a consistent reduction in clinically relevant complications, reaching significance for the composite endpoint at one year. These findings support a potential role for optimised periprocedural oxygenation in longterm organ protection and warrant validation in larger multicentre trials.For image description, please refer to the figure legend and surrounding text.