Incidence and Effect of Acute Kidney Injury After Transcatheter Aortic Valve Replacement Using the New Valve Academic Research Consortium Criteria

Abstract

Acute kidney injury (AKI) is associated with a poor prognosis after transcatheter aortic valve replacement (TAVR). A paucity of data exists regarding the incidence and effect of AKI after TAVR using the new recommended Valve Academic Research Consortium criteria. At Columbia University Medical Center, 218 TAVR procedures (64.2% transfemoral, 35.8% transapical) were performed from 2008 to July 2011. The creatinine level was evaluated daily until discharge. Using the Valve Academic Research Consortium definitions, the 30-day and 1-year outcomes were compared between patients with significant AKI (AKI stage 2 or 3) and those without significant AKI (AKI stage 0 or 1). Significant AKI occurred in 18 patients (8.3%). Of these 18 patients, 10 (55.6%) had AKI stage 3 and 9 (50%) required dialysis. AKI was associated with a lower baseline mean transvalvular gradient (37.6 ± 11.4 vs 45.6 ± 14.8 mm Hg for no AKI, p = 0.03). After TAVR, the AKI group had a greater hemoglobin decrease (3.6 ± 2.0 vs 2.4 ± 1.3 g/dl, p = 0.01), greater white blood cell elevation at 72 hours (21.09 ± 12.99 vs 13.18 ± 4.82 × 103/μl, p = 0.001), a more severe platelet decrease (118 ± 40 vs 75 ± 43 × 103/μl, p <0.0001), and longer hospitalization (10.7 ± 6.4 vs 7.7 ± 8.5 days, p <0.001). One stroke (5.6%) occurred in the AKI group compared with 3 (1.5%) in the group without AKI (p = 0.29). The 30-day and 1-year rates of death were significantly greater in the AKI group than in the no-AKI group (44.4% vs 3.0%, hazard ratio 18.1, 95% confidence interval 6.25 to 52.20, p <0.0001; and 55.6% vs 16.0%, hazard ratio 6.32, 95% confidence interval 3.06 to 13.10, p <0.0001, respectively). Periprocedural life-threatening bleeding was the strongest predictor of AKI after TAVR. In conclusion, the occurrence of AKI, as defined by the Valve Academic Research Consortium criteria, is associated with periprocedural complications and a poor prognosis after TAVR.

Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States

“…[21][22][23] Postprocedural AKI occurs in 12% to 57% of patients after TAVR and is associated with increased mortality. 24,25 AKI also predicted increased 30-day readmission after TAVR in our study. Discharge to SNF and prolonged LOS, which may reflect frailty and high burden of comorbidities and in-hospital complications, were also associated with increased rates of 30-day readmission.…”

Meta-Analysis of Predictors of All-Cause Mortality After Transcatheter Aortic Valve Implantation

“…4 3.1% and was above 20% in all studies, except for one (19 13%). 21 In those studies (n ¼ 5) in which reporting results was exclusively done using the Society of Thoracic Surgery score, 22,25,28,32,35 the mean risk of perioperative mortality was >5%. Diabetes mellitus was present in 24% (n ¼ 2,153) of patients, renal insufficiency in 48% (n ¼ 4,264), and a history of previous revascularization (either surgical or percutaneous) in 40% (n ¼ 3,541).…”

“…Left ventricular ejection fraction (LVEF) was in general preserved, except for 3 studies in which mean LVEF was mildly compromised (range of mean LVEF 47% to 60%). 26,27,32 The most important baseline characteristics are reported in Table 1. 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 610 611 612 613 614 615 616 617 618 619 620 621 622 623 624 625 626 627 628 629 630 631 632 633 634 635 636 637 638 639 640 641 642 643 644 645 646 647 648 649 650 651 652 653 654 655 656 657 658 659 660 A small majority of patients were treated by the transfemoral approach (51.1%), followed by the transapical approach (33.7%), and only few patients received a direct aortic or trans-subclavian procedure (1.5% and 0.2%, respectively).…”

Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis

“…We did, however, find a significant decrease in acute renal failure and an increase in rates of pacemaker implantations in the TAVR group as compared to SAVR group. Although the incidence of acute renal failure has been examined in other trials (21)(22)(23)(24), this is the first instance where a large data set has detected a significant benefit of TAVR over SAVR in a non-high risk population. Our data suggests that TAVR may result in improved neurologic outcomes and reduced post-procedure MIs but this study lacked the power to demonstrate a statistically significant difference.…”