Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement

Abstract

AimsVery few data exist on the occurrence of acute kidney injury (AKI) associated with transcatheter aortic valve implantation (TAVI). The objectives of the present study were (i) to determine the incidence, predictive factors, and prognostic value of AKI following TAVI, and (ii) to compare the occurrence of AKI in TAVI vs. surgical aortic valve replacement (SAVR) in patients with pre-procedural chronic kidney disease (CKD).Methods and resultsA total of 213 patients (mean age 82 ± 8 years) undergoing TAVI for the treatment of severe aortic stenosis were included in the study. Acute kidney injury was defined as a reduction of >25% in estimated glomerular filtration rate (eGFR) within 48 h following the procedure or the need for haemodialysis during index hospitalization. Those patients with pre-procedural CKD (eGFR <60 mL/min/1.73 m2, n = 119) were compared with 104 contemporary patients with CKD who underwent isolated SAVR. The incidence of AKI following TAVI was 11.7%, with 1.4% of the patients requiring haemodialysis. Predictive factors of AKI were hypertension (OR: 4.66; 95% CI: 1.04–20.87), chronic obstructive pulmonary disease (OR: 2.64, 95% CI: 1.10–6.36), and peri-operative blood transfusion (OR: 3.47, 95% CI: 1.30–9.29). Twenty-one patients (9.8%) died during index hospitalization, and the logistic EuroSCORE (OR: 1.03 for each increase of 1%; 95% CI: 1.01–1.06) and occurrence of AKI (OR: 4.14, 95% CI: 1.42–12.13) were identified as independent predictors of postoperative mortality. Patients with CKD who underwent TAVI were older, had a higher logistic EuroSCORE and lower pre-procedural eGFR values compared with those who underwent SAVR (P < 0.0001 for all). The incidence of AKI was lower (P = 0.001; P = 0.014 after propensity score adjustment) in CKD patients who underwent TAVI (9.2%, need for haemodialysis: 2.5%) compared with those who underwent SAVR (25.9%, need for haemodialysis: 8.7%).ConclusionAcute kidney injury occurred in 11.7% of the patients following TAVI and was associated with a greater than four-fold increase in the risk of postoperative mortality. Hypertension, chronic obstructive pulmonary disease, and blood transfusion were predictive factors of AKI. In those patients with pre-procedural CKD, TAVI was associated with a significant reduction of AKI compared with SAVR.

Predictors of Death and Dialysis in Severe AKI

“…Many studies examining the predictors of death in AKI are restricted to patients who received acute dialysis (3)(4)(5)(6)(7)(8)(9), limiting generalizable inferences regarding the broader AKI population. Other studies have enrolled patients after consultation with a nephrologist (10), restricted to intensive care unit (ICU) settings (2), or after surgical procedures (11)(12)(13)(14). Some observational studies lack the patient-level data needed to adequately adjust for comorbid illness, and utilize limited registry data to categorize AKI (15).…”

A Simplified Protocol for Transcatheter Aortic Valve Implantation that Reduces Procedure-Related Risk

“…We have successively simplified our procedure protocol with the result that some complications associated with the procedure have been reduced or totally avoided. Elderly patients with impaired kidney function are more at risk for acute renal failure and are sensitive to contrast medium, though some controversy exists about the negative effect of contrast delivery in association with TAVI [14,15]. In a large multicenter study, Barbanti et al [7] reported that acute kidney injury is a frequent complication and has significant impact on both early and long-term TAVI survival [7].…”

Manejo anestésico e complicações no implante percutâneo de válvula aórtica

“…A limited clinical experiment suggests that the renal function often improves with the best cardiac output after AE correction. ARF is usually mild and easily reversed and less common than in surgical patients 33 . Coronary obstruction rarely occurs and is a result of the native valve displacement of the left coronary ostium.…”