Predictors of Acute Kidney Injury After Transcatheter Aortic Valve Implantation (From National Inpatient Sample [2011-2018])

Zahid, Salman; Ullah, Waqas; Khan, Muhammad Usman; Salama, Amr; Krupica, Troy; Khan, Muhammad Zia

doi:10.1016/j.amjcard.2021.04.003

Cited by 6 publications

(9 citation statements)

References 10 publications

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“…At a nationwide level, the researchers found the hospitalization cost associated with AKI postcardiac surgery to be $1.01 billion, 35 illustrating how even a 10% decrease in the rate of AKI could result in massive cost savings for hospitals. Similar results were recently reported in an analysis of the National Inpatient Sample (United States) illustrating that patients with AKI undergoing TAVR were subject to both an increase in the cost of hospital stay ($2,58,056 vs. $1,74,673) and length of stay (9 vs. 3 days) 36 . Although, comparative data regarding the additional costs of AKI development post‐ViV‐TAVR and redo SAVR is lacking, knowledge from studies on TAVR and SAVR underline the massive impact of this complication.…”

Section: Discussionsupporting

confidence: 86%

Renal outcomes in valve‐in‐valve transcatheter versus redo surgical aortic valve replacement: A systematic review and meta‐analysis

Rad

Naruka

Vardanyan

et al. 2022

Journal of Cardiac Surgery

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Introduction Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve‐in‐valve aortic valve replacement (ViV‐TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population undergoing either redo SAVR or ViV‐TAVR remains controversial. Methods A systematic database search with meta‐analysis was conducted of comparative original articles of ViV‐TAVR versus redo SAVR in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to September 2021. Primary outcomes were AKI and RRT. Secondary outcomes were stroke, major bleeding, pacemaker implantation rate, operative mortality, and 30‐day mortality. Results Our search yielded 5435 relevant studies. Eighteen studies met the inclusion criteria with a total of 11,198 patients. We found ViV‐TAVR to be associated with lower rates of AKI, postoperative RRT, major bleeding, pacemaker implantation, operative mortality, and 30‐day mortality. No significant difference was observed in terms of stroke rate. The mean incidence of AKI in ViV‐TAVR was 6.95% (±6%) and in redo SAVR was 15.2% (±9.6%). For RRT, our data showed that VIV‐TAVR to be 1.48% (±1.46%) and redo SAVR to be 8.54% (±8.06%). Conclusion Renoprotective strategies should be put into place to prevent and reduce AKI incidence regardless of the treatment modality. Patients undergoing re‐intervention for the aortic valve constitute a high‐risk and frail population in which ViV‐TAVR demonstrated it might be a feasible option for carefully selected patients. Long‐term follow‐up data and randomized control trials will be needed to evaluate mortality and morbidity outcomes between these 2 treatments.

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Section: Discussionsupporting

confidence: 86%

Renal outcomes in valve‐in‐valve transcatheter versus redo surgical aortic valve replacement: A systematic review and meta‐analysis

Rad

Naruka

Vardanyan

et al. 2022

Journal of Cardiac Surgery

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“…A previous study reported that major bleeding and life-threatening bleeding after TAVR, as defined by the Valve Academic Research Consortium (VARC) criteria, occurred in approximately 15-20% of TAVR procedures [13]. Factors that increase the risk of bleeding include a high prevalence of CKD, peripheral vasculopathy, acquired thrombocytopenia, and acquired reversible von Willebrand factor deficiency [16,[19][20][21]. It is important to note that our definition of major bleeding was not based on well-validated VARC-II criteria similar to previous studies, instead, we used ICD codes to define major bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…After the procedure, patients undergoing TAVR had lower rates of major or life-threatening bleeding (11.3% vs. 20.9%), acute kidney injury (AKI) stage II and III, and cardiogenic shock compared to those undergoing SAVR [13,[20][21][22][23][24][25][26]. Due to the inherent platelet dysfunction, patients with ESRD have a propensity to bleed and are associated with high mortality [19,20]. Similarly, due to associated coagulopathy, liver disease patients have an increased tendency to bleed [27].…”

Section: Discussionmentioning

confidence: 99%

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

Khan¹,

Gilani²,

Qayum³

et al. 2021

Cureus

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BackgroundTranscatheter aortic valve replacement (TAVR) is now a common procedure to treat and improve quality of life, clinical outcomes, and self-sufficiency in high-risk patients with aortic stenosis, and its use has been expanding rapidly in younger and low-risk populations. The aim of this study was to evaluate the outcomes, trends, and predictors of major bleeding in patients undergoing TAVR. MethodologyWe utilized the National Inpatient Sample (NIS) data from the year 2015 to 2018. International Classification of Disease 10 codes were utilized to extract data. Baseline characteristics were compared using Pearson's chisquare test for categorical variables and independent samples t-test for continuous variables. A multivariable logistic regression model was used to evaluate the predictors of major bleeding. Propensity matching was done for adjusted analysis to compare outcomes in TAVR with and without major bleeding. The outcomes of interest in this study were (1) predictors of major bleeding after TAVR; (2) in-hospital mortality; and (3) resource utilization in terms of cost and length of stay. ResultsA total of 34,752 weighted hospitalizations for TAVR were included in the analysis. Of the patients undergoing the procedure, 2,294 (6.6%) had a major bleed while 32,458 (93.3%) did not. At baseline, patients with coagulopathy (odds ratio [OR]: 2.03; 95% confidence interval [

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“…Second, perfusion parameters, such as CPB duration and the nadir hematocrit level during CPB were associated with AKI occurrence. AKI is one of the most common complications of cardiac surgery and also associated with increase mortality in cardiac procedures (7). Among many factors, the use of CPB is a major contributor to AKI after cardiac surgery: it predisposes the patient to the systemic inflammatory response, ischemia-reperfusion injury, and pigment nephropathy due to rhabdomyolysis and hemolysis (8,11).…”

Section: Discussionmentioning

confidence: 99%

“…However, the rate of postoperative acute kidney injury (AKI) was increased in previous studies (5,6). A previous study also showed that the development of postprocedural AKI is associated with an increase mortality (7). A recent study showed that concomitant maze procedure increased the risk of postoperative AKI, which was offset by the significant survival benefit of the maze procedure (8).…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors of acute kidney injury after maze operation in patients with rheumatic mitral valve disease

Hong¹,

Lee²,

Kim³

et al. 2022

J Thorac Dis

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Background: Acute kidney injury (AKI) is one of the most common complications after cardiac surgery.While current guidelines indicate that surgical ablation does not increase the risk of renal failure, recent studies have produced conflicting results. This study was conducted to evaluate the incidence of AKI after maze procedure in patients with rheumatic mitral valve disease and atrial fibrillation, and to elucidate risk factors associated with postoperative AKI.Methods: Between 2011 and 2020, 203 patients with rheumatic mitral valve disease and atrial fibrillation (61.4±8.7 years, male:female =67:136) who underwent concomitant maze procedure and mitral valve replacement were retrospectively reviewed. Other combined procedures included aortic valve operations (n=64, 31.5%) and tricuspid valve procedures (n=149, 73.4%). The AKI was defined as an increase of serum creatinine level by 1.5 times after surgery based on the RIFLE (Risk, Injury, Failure, Loss, and End stage) criteria. A multivariable logistic regression analysis was performed to evaluate risk factors associated with postoperative AKI.Results: Postoperative AKI developed in 76 patients (37.4%). The multivariable analysis demonstrated that age (odds ratio, 95% CI: 1.065, 1.025-1.107; P=0.001), cardiopulmonary bypass (CPB) time (1.007, 1.002-1.013; P=0.009) and nadir hematocrit during CPB (0.854, 0.740-0.985; P=0.031) were associated with postoperative AKI.Conclusions: Postoperative AKI occurred in more than one thirds of patients with rheumatic mitral valve disease and atrial fibrillation who underwent combined mitral valve replacement and maze procedure.Optimization of CPB management might be needed to prevent postoperative AKI after maze procedure.

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Predictors of Acute Kidney Injury After Transcatheter Aortic Valve Implantation (From National Inpatient Sample [2011-2018])

Cited by 6 publications

References 10 publications

Renal outcomes in valve‐in‐valve transcatheter versus redo surgical aortic valve replacement: A systematic review and meta‐analysis

Renal outcomes in valve‐in‐valve transcatheter versus redo surgical aortic valve replacement: A systematic review and meta‐analysis

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

Incidence and risk factors of acute kidney injury after maze operation in patients with rheumatic mitral valve disease

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