Acute kidney injury after transcatheter aortic valve implantation and mortality risk—long-term follow-up

Bassat, Orit Kliuk‐Ben; Finkelstein, Ariel; Bazan, Samuel; Halkin, Amir; Herz, Itzhak; Gotler, Dalit Salzer; Ravid, Dor; Hakakian, Odelia; Keren, Gad; Banai, Shmuel; Arbel, Yaron

doi:10.1093/ndt/gfy264

Cited by 25 publications

(21 citation statements)

References 28 publications

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“…Similarly, Bagur et al showed that 9% suffered from AKI after TAVR, whereas SAVR was associated with an incidence of AKI in 26% [24]. These results could be of impact, in fact, AKI was associated with an increased risk of 30-day and long-term (up to seven years) mortality (42.3% versus 22.7% for seven-year mortality; HR 1.71 (95% CI 1.30-2.25)) [25].…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients for the Treatment of Severe Aortic Stenosis

Polimeni

Sorrentino

Rosa

et al. 2020

JCM

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Recently, two randomized trials, the PARTNER 3 and the Evolut Low Risk Trial, independently demonstrated that transcatheter aortic valve replacement (TAVR) is non-inferior to surgical aortic valve replacement (SAVR) for the treatment of severe aortic stenosis in patients at low surgical risk, paving the way to a progressive extension of clinical indications to TAVR. We designed a meta-analysis to compare TAVR versus SAVR in patients with severe aortic stenosis at low surgical risk. The study protocol was registered in PROSPERO (CRD42019131125). Randomized studies comparing one-year outcomes of TAVR or SAVR were searched for within Medline, Scholar and Scopus electronic databases. A total of three randomized studies were selected, including nearly 3000 patients. After one year, the risk of cardiovascular death was significantly lower with TAVR compared to SAVR (Risk Ratio (RR) = 0.56; 95% CI 0.33–0.95; p = 0.03). Conversely, no differences were observed between the groups for one-year all-cause mortality (RR = 0.67; 95% CI 0.42–1.07; p = 0.10). Among the secondary endpoints, patients undergoing TAVR have lower risk of new-onset of atrial fibrillation compared to SAVR (RR = 0.26; 95% CI 0.17–0.39; p < 0.00001), major bleeding (RR = 0.30; 95% CI 0.14–0.65; p < 0.002) and acute kidney injury stage II or III (RR = 0.28; 95% CI 0.14–0.58; p = 0.0005). Conversely, TAVR was associated to a higher risk of aortic regurgitation (RR = 3.96; 95% CI 1.31–11.99; p = 0.01) and permanent pacemaker implantation (RR = 3.47; 95% CI 1.33–9.07; p = 0.01) compared to SAVR. No differences were observed between the groups in the risks of stroke (RR= 0.71; 95% CI 0.41–1.25; p = 0.24), transient ischemic attack (TIA; RR = 0.98; 95% CI 0.53–1.83; p = 0.96), and MI (RR = 0.75; 95% CI 0.43–1.29; p = 0.29). In conclusion, the present meta-analysis, including three randomized studies and nearly 3000 patients with severe aortic stenosis at low surgical risk, shows that TAVR is associated with lower CV death compared to SAVR at one-year follow-up. Nevertheless, paravalvular aortic regurgitation and pacemaker implantation still represent two weak spots that should be solved.

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Section: Discussionmentioning

confidence: 99%

Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients for the Treatment of Severe Aortic Stenosis

Polimeni

Sorrentino

Rosa

et al. 2020

JCM

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“… 5 - 8 Acute kidney injury complicating TAVR is associated with a higher mortality risk during short- and long-term follow-up. 9 - 11 In most patients who develop AKI, kidney function recovers partially or completely. Nonetheless, mortality risk remains high.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Kidney Function After Transcatheter Aortic Valve Replacement

Bassat

Sadon

Sirota

et al. 2021

Can J Kidney Health Dis

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Background: Transcatheter aortic valve replacement (TAVR), although associated with an increased risk for acute kidney injury (AKI), may also result in improvement in renal function. Objective: The aim of this study is to evaluate the magnitude of kidney function improvement (KFI) after TAVR and to assess its significance on long-term mortality. Design: This is a prospective single center study. Setting: The study was conducted in cardiology department, interventional unit, in a tertiary hospital. Patients: The cohort included 1321 patients who underwent TAVR. Measurements: Serum creatinine level was measured at baseline, before the procedure, and over the next 7 days or until discharge. Methods: Kidney function improvement was defined as the mirror image of AKI, a reduction in pre-procedural to post-procedural minimal creatinine of more than 0.3 mg/dL, or a ratio of post-procedural minimal creatinine to pre-procedural creatinine of less than 0.66, up to 7 days after the procedure. Patients were categorized and compared for clinical endpoints according to post-procedural renal function change into 3 groups: KFI, AKI, or preserved kidney function (PKF). The primary endpoint was long-term all-cause mortality. Results: The incidence of KFI was 5%. In 55 out of 66 patients patients, the improvement in kidney function was minor and of unclear clinical significance. Acute kidney injury occurred in 19.1%. Estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 was a predictor of KFI after multivariable analysis (odds ratio = 0.93 to develop KFI; confidence interval [95% CI]: 0.91-0.95, P < .001). Patients in the KFI group had a higher Society of Thoracic Surgery (STS) score than other groups. Mortality rate did not differ between KFI group and PKF group (43.9% in KFI group and 33.8% in PKF group) but was significantly higher in the AKI group (60.7%, P < .001). Limitations: The following are the limitations: heterozygous definitions of KFI within different studies and a single center study. Although data were collected prospectively, analysis plan was defined after data collection. Conclusions: Improvement in kidney function following TAVR was not a common phenomenon in our cohort and did not reduce overall mortality rate.

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“…Acute kidney injury (AKI) is a well-known complication post invasive cardiac procedure [1]. In the past, contrast material was considered the main culprit.…”

Section: Introductionmentioning

confidence: 99%

NGAL in trans-catheter aortic valve implantation on and off RenalGuard

2021

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Introduction: Acute kidney injury (AKI) is a well-known complication post invasive cardiac procedures. RenalGuard system has been shown to reduce the risk of AKI in high-risk patients by evacuating iodine-based contrast material rapidly. Neutrophil gelatinase-associated lipocalin (NGAL) is a glycoprotein stored in granules of mature neutrophils and is released to the blood stream due to acute tubular damage. This report examined the biomarker as a sub study of the randomized sham control study REDUCE-AKI in the setting of Trans-Aortic Valve Implantation (TAVI). Methods: Venous blood was drawn from 27 patients. Blood was drawn at designated time intervals: before the procedure, after 12 hours and after 24 hours. Patients were randomly allocated to active versus sham RenalGuard activity. Results: There was no difference between baseline and 24 hours levels in NGAL values (ng/mL) in the sham group (median 70.3 IQ 21.5, 176.6) versus the active group (median 46.9, IQR 1.3, 127.7) (P = 0.259). There was also no association between NGAL and clinical complications. Conclusion: Forced diuresis with matched hydration does not prevent AKI in patients undergoing TAVI and measuring NGAL correlates with these findings.

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Acute kidney injury after transcatheter aortic valve implantation and mortality risk—long-term follow-up

Abstract: Periprocedural AKI following TAVI is a strong risk factor for short-term as well as long-term mortality (up to 7 years). Therefore more effort is needed to reduce this complication.

Cited by 25 publications

References 28 publications

Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients for the Treatment of Severe Aortic Stenosis

Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients for the Treatment of Severe Aortic Stenosis

Assessment of Kidney Function After Transcatheter Aortic Valve Replacement

NGAL in trans-catheter aortic valve implantation on and off RenalGuard

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