Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Replacement

Julien, Howard; Stebbins, Amanda; Vemulapalli, Sreekanth; Nathan, Ashwin S.; Eneanya, Nwamaka D.; Groeneveld, Peter W.; Fiorilli, Paul N.; Herrmann, Howard C.; Szeto, Wilson Y.; Desai, Nimesh D.; Anwaruddin, Saif; Vora, Amit N.; Shah, Binita; Ng, Vivian G.; Kumbhani, Dharam J.; Giri, Jay

doi:10.1161/circinterventions.120.010032

Cited by 30 publications

(19 citation statements)

References 33 publications

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“…The association between acute kidney injury after interventional and surgical procedures and mortality has been described in numerous studies [ 24 – 27 ]. The reported incidence of AKIN after TAVI is heterogenous varying between 3.4 % and 57 %, which is comparable with our local results [ 28 – 30 ]. The etiology of an acute kidney injury following TAVI is multifactorial.…”

Section: Discussionsupporting

confidence: 92%

Development of In-Hospital Outcomes in Patients undergoing Transcatheter Aortic Valve Implantation (TAVI) at an Interdisciplinary Heart Center: A Single-Center Experience of 489 Consecutive Cases

Rana¹,

Niethammer²,

Sellin³

et al. 2023

Cardiol Cardiovasc Med

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Background: Transcatheter Aortic Valve Implantation (TAVI) has emerged over time, reflected in appropriate adjustments in the European Society of Cardiology (ESC) guidelines in 2007, 2012 and 2017. Objective: The aim of this study was to analyze in-hospital outcomes after TAVI in the development within a single heart center over a period of 10 years depending on adjustments in the guidelines, infrastructural and procedural determinants. Methods: 489 consecutive patients who underwent TAVI from 2010 and 2019 at our center were analyzed retrospectively. Patients were divided into 3 groups of different treatment circumstances depending on guidelines adjustments and local infrastructural progress (group 1: 2010–2015 (n = 132), group 2: 2016–2017 (n = 155), group 3: 2018–2019 (n = 202). The primary endpoint was defined as all-cause in-hospital mortality. Secondary endpoints were selected according to the Valve Academic Research Consortium (VARC)-2 definitions. Multivariate logistic regression analysis was performed to determine predictors of in-hospital mortality. Statistical significance was assumed for p < 0.05. Results: 489 patients (346 (70.8 %) transfemoral and 143 (29.2 %) transapical) underwent TAVI. Comparing periods (group 1 vs. 2 vs. 3) age (82.1 ± 6.2 vs. 82.5 ± 4.8 vs. 81.1 ± 5.1 years, p = 0.012) and EuroSCORE II (8.4 ± 6.0 vs. 5.8 ± 4.9 vs. 5.5 ± 5.0 %, p < 0.001) declined over time. Rates of in-hospital mortality decreased significantly (9.1 % vs. 5.8 % vs. 2.5 %, p = 0.029), especially with observed-to-expected mortality ratios indicating a disproportionate decline of in-hospital mortality (1.08 vs. 1.00 vs. 0.45). Furthermore, post-procedural complications, such as acute kidney injury stage 3 (10.6 % vs. 3.2 % vs. 4.5 %, p = 0.016) and bleeding complications (14.4 % vs. 11.6 % vs 7.9 %, p = 0.165) decreased from group 1 to 3. However, rates of permanent pacemaker implantations (7.6 % vs. 11.0 % vs. 22.8 %, p < 0.001) increased, associated with a switch towards self-expanding valves (0.0 % vs. 61.3 % vs. 76.7 %, p < 0.001). Length of hospitalization as well as stay at intensive care and intermediate care unit could be reduced significantly during the observation period. In multivariate analysis age (OR: 1.103; 95 % CI: 1.013 – 1.202; p = 0.025), creatinine level before TAVI (OR: 1.497; 95 % CI: 1.013 – 2.212; p = 0.043), atrial fibrillation (OR: 2.956; 95 % CI: 1.127 – 7.749; p = 0.028) and procedure duration (OR: 1.017; 95 % CI: 1.009 – 1.025; p < 0.001) could be identified as independent predictors of in-hospital mortality. Conclusion: This study identified age, creatinine level before TAVI, the presence of atrial fibrillation and procedure duration as independent predictors for in-hospital mortality. Although these predictors decreased during the observation period, the decline in hospital-mortality was disproportionate, which was indicated by an observed-to-expected m...

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Section: Discussionsupporting

confidence: 92%

Development of In-Hospital Outcomes in Patients undergoing Transcatheter Aortic Valve Implantation (TAVI) at an Interdisciplinary Heart Center: A Single-Center Experience of 489 Consecutive Cases

Rana¹,

Niethammer²,

Sellin³

et al. 2023

Cardiol Cardiovasc Med

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Section: Incidence Of Tavr-associated Akimentioning

confidence: 99%

“…In the recent work by Julien et al [13], out of 107,814 patients who had TAVR in the USA, 11?,566 (10.7%) experienced postprocedural AKI. Among patients who developed AKI, 10?,220 (9.5%) experienced stage 1 AKI, 134 (0.1%) stage 2 AKI, and 1,212 (1.1%) stage 3 AKI [13]. However, the incidence of AKI after TAVR seems to be improving in the latest registries, perhaps owing to significant improvement in technology and surgeon experience [13].…”

Section: Incidence Of Tavr-associated Akimentioning

confidence: 99%

“…Among patients who developed AKI, 10 ,220 (9.5%) experienced stage 1 AKI, 134 (0.1%) stage 2 AKI, and 1,212 (1.1%) stage 3 AKI [13]. However, the incidence of AKI after TAVR seems to be improving in the latest registries, perhaps owing to significant improvement in technology and surgeon experience [13]. A similar study by Abbas et al [10], utilizing the US National Inpatient registry, reported a similar percentage at 11.5% (20,045/173,760).…”

Section: Introductionmentioning

confidence: 99%

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Transcatheter Aortic Valve Replacement-Associated Acute Kidney Injury: An Update

et al. 2023

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Background: Transcatheter Aortic Valve Replacement (TAVR) is a relatively novel minimally invasive procedure for the treatment of symptomatic patients with severe aortic stenosis. Although it has been proven effective in improving mortality and quality of life, TAVR is associated with serious complications, such as acute kidney injury (AKI). Summary: TAVR-associated AKI is likely due to several factors such as sustained hypotension, transapical approach, volume of contrast use and baseline low GFR. This narrative review aims to present an overview of the latest literature and evidence regarding the definition of TAVR-associated AKI, its risk factors, and its impact on morbidity and mortality. The review used a systematic search strategy with multiple health-focused databases (Medline, EMBASE), and identified 8 clinical trials and 27 observational studies concerning TAVR-associated AKI. Results showed that TAVR-associated AKI is linked to several modifiable and non-modifiable risk factors, and is associated with higher mortality. A variety of diagnostic imaging modalities have the potential to identify patients at high-risk for development of TAVR-AKI; however, there are no existing consensus recommendations regarding their use as of this time. The implications of these findings highlight the importance of identifying high-risk patients for which preventive measures may play a crucial role, and should be maximized. Key Message: This study reviews the current understanding of TAVR-associated AKI including its pathophysiology, risk factors, diagnostic modalities, and preventative management for patients.

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“…Previous studies showed that patients have an increased risk of postoperative AKI after TAVI, but whether differences in patient risk profiles confounded the results is unclear [49]. In the recent work by Julien et al [50], out of 107,814 patients who had TAVI in the US, 11,566 (10.7%) experienced postprocedural AKI. Among patients who developed AKI, 10,220 (9.5%) developed stage 1 AKI, 134 (0.1%) stage 2 AKI, and 1212 (1.1%) stage 3 AKI.…”

Section: Acute Kidney Injurymentioning

confidence: 99%

Transcatheter Aortic Valve Implantation Outcomes and Challenges in Asia: A Systematic Review and Meta-Analysis

Rivera¹,

Luna²,

Ansay³

et al. 2023

Rev. Cardiovasc. Med.

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Background: Aortic stenosis (AS) is the world's most prevalent heart valve disease. Transcatheter aortic valve replacement (TAVR) or Implantation (TAVI) is widely available yet adopting this procedure in Asia has been slow due to high device cost, the need for specific training programs, and the lack of specialized heart teams and dedicated infrastructures. The limited number of randomized controlled trials describing TAVI outcomes among the Asian population hampered the approval for medical reimbursements as well as acceptance among surgeons and operators in some Asian countries. Methods: A comprehensive medical literature search on TAVI and/or TAVR performed in Asian countries published between January 2015 and June 2022 was done through MEDLINE and manual searches of bibliographies. The full text of eligible articles was obtained and evaluated for final analysis. The event rates for key efficacy and safety outcomes were calculated using the data from the registries and randomized controlled trials. Results: A total of 15,297 patients were included from 20 eligible studies. The mean patient age was 82.88 ± 9.94 years, with over half being females (62.01%). All but one study reported Society of Thoracic Surgeons (STS) scores averaging an intermediate risk score of 6.28 ± 1.06%. The mean logistic European Systems for Cardiac Operations Risk Evaluation (EuroSCORE) was 14.85. The mean baseline transaortic gradient and mean aortic valve area were 50.93 ± 3.70 mmHg and 0.64 ± 0.07 cm 2 , respectively. The mean procedural success rate was 95.28 ± 1.51%. The weighted mean 30-day and 1-year all-cause mortality rate was 1.66 ± 1.21% and 8.79 ± 2.3%, respectively. The mean average for stroke was 1.98 ± 1.49%. The acute kidney injury (AKI) rate was 6.88 ± 5.71%. The overall major vascular complication rate was 2.58 ± 2.54%; the overall major bleeding rate was 3.88 ± 3.74%. Paravalvular aortic regurgitation rate was 15.07 ± 9.58%. The overall rate of pacemaker insertion was 7.76 ± 4.6%. Conclusions: Compared to Americans and Europeans, Asian patients who underwent TAVI had lower all-cause mortality, bleeding, and vascular complications, however, had a higher rate of postprocedural aortic regurgitation. More studies with greater sample sizes are needed among Asian patients for a more robust comparison.

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Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Replacement

Cited by 30 publications

References 33 publications

Development of In-Hospital Outcomes in Patients undergoing Transcatheter Aortic Valve Implantation (TAVI) at an Interdisciplinary Heart Center: A Single-Center Experience of 489 Consecutive Cases

Development of In-Hospital Outcomes in Patients undergoing Transcatheter Aortic Valve Implantation (TAVI) at an Interdisciplinary Heart Center: A Single-Center Experience of 489 Consecutive Cases

Transcatheter Aortic Valve Replacement-Associated Acute Kidney Injury: An Update

Transcatheter Aortic Valve Implantation Outcomes and Challenges in Asia: A Systematic Review and Meta-Analysis

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