Acute kidney injury after transcatheter aortic valve implantation: Incidence, predictors and impact on mortality

Abstract

There is a paucity of data describing acute kidney injury (AKI) following transcatheter aortic valve implantation and its impact on mortality remains unknown. We therefore evaluate the incidence, predictors and impact of AKI following transcatheter aortic valve implantation. We searched MEDLINE for studies from 2008 to 2013, evaluating AKI after transcatheter aortic valve implantation. All studies were compared according to the incidence, predictors and impact of AKI following transcatheter aortic valve implantation. AKI was diagnosed according to the Valve Academic Research Consortium definition using the RIFLE criteria. Thirteen studies with more than 1900 patients were included. AKI occurred in 8.3-57% of the patients. The following factors were associated with AKI: blood transfusion; transapical access; preoperative creatinine concentration; peripheral vascular disease; hypertension; and procedural bleeding events. The 30-day mortality rate in patients with AKI ranged from 13.3% to 44.4% and was 2-6-fold higher than in patients without AKI. The amount of contrast agent used was not associated with the occurrence of AKI. AKI is a common complication, with an incidence of 8.3-57% following transcatheter aortic valve implantation. Patients with AKI had higher 30-day and late mortality rates. However, AKI was related to the amount of contrast volume used in only one study.

Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States

“…Paravalvular leak (PVL) may be an independent predictor of mortality, with increased morbidity and mortality among patients with more than mild PVL [4,25,26]. In the PARTNER trial, moderate or severe paravalvular aortic regurgitation was apparent in 11.8% of inoperable patients and in 12.2% of high-risk patients [1,2].…”

Association of frailty status with acute kidney injury and mortality after transcatheter aortic valve replacement: A systematic review and meta-analysis

“…To date, more than 200,000 TAVR procedures have been performed [6, 7]. Although TAVR is considered a less invasive treatment compared with SAVR, the one and two year mortality following TAVR is still considerable at 24% and 34%, respectively [8, 9].…”

“…Although TAVR is considered a less invasive treatment compared with SAVR, the one and two year mortality following TAVR is still considerable at 24% and 34%, respectively [8, 9]. Acute kidney injury (AKI) after TAVR is common with a varied reported incidence ranging from 15% to 57% [2, 6, 10, 11]. Studies have demonstrated significant associations between AKI and decreased survival in patients undergoing TAVR [7, 10, 12].…”

Intensive Care Unit Management of Transcatheter Aortic Valve Recipients

“…65 A recent analysis examining 13 studies with more than 1900 patients found that acute kidney injury (AKI) occurred in 8.3% to 57% of patients following TAVI (Table 2). 66 Factors noted to be associated with AKI include blood transfusion, TA approach, preoperative creatinine (Cr) >1.1 mg/dL, peripheral vascular disease, hypertension, and bleeding. 66,67 Development of AKI is associated with a significant increase in both 30-day and late mortality, 68,69 and the need for renal replacement therapy (dialysis) post-TAVR confers a 10% increase in mortality rate.…”