The Negative Effect of Mean Perfusion Pressure on the Development of Acute Kidney Injury after Transcatheter Aortic Valve Implantation

Abstract

ObjectiveTo evaluate the predictive value of mean perfusion pressure (mPP) in the development of acute kidney injury (AKIN) after transcatheter aortic valve implantation (TAVI).MethodsOne hundred and forty seven consecutive patients with aortic stenosis (AS) were evaluated for this study and 133 of them were included. Mean arterial pressure (mAP) and central venous pressure (CVP) were used to calculate mPP before TAVI procedure (mPP = mAP-CVP). The occurrence of AKIN was evaluated with AKIN classification according to the Valve Academic Research Consortium-2 recommendations. The patients were divided into two groups according to the receiver operating characteristic (ROC) analysis of their mPP levels (high-risk group and low-risk group).ResultsThe AKIN prevalence was 22.6% in this study population. Baseline serum creatinine level, glomerular filtration rate, amount of contrast medium, and the level of mPP were determined as predictive factors for the development of AKIN.ConclusionThe occurrence of AKIN is associated with increased morbidity and mortality rates in patients with TAVI. In addition to the amount of contrast medium and basal kidney functions, our study showed that lower mPP was strongly associated with development of AKIN after TAVI.

The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study

“…Greater relative hypotension was caused by higher preoperative or lower postoperative MPP, while smaller relative hypotension was caused by lower preoperative or higher postoperative MPP. Since previous studies [ 16 , 17 , 38 ] and our study have consistently shown that lower postoperative MPP is a risk factor of AKI, the non-linear relationship between preoperative MPP and AKI progression could weaken the association between relative hypotension and AKI progression. Higher preoperative MPP could increase the risk of AKI due to the right shift in the lower pressure limit of renal autoregulation in the presence of chronic hypertension [ 14 ].…”

“…Mean perfusion pressure (MPP), which is the difference between MAP and central venous pressure (CVP), can also be used as a surrogate marker for renal perfusion because elevated CVP has been reported as a risk factor for AKI in ICU patients [ 13 , 14 ]. Although CVP monitoring is readily available in patients after cardiac surgery [ 15 ], few studies have assessed the relationship between MPP and AKI in this population [ 16 , 17 ].…”

Impact of contrast medium osmolality on the risk of acute kidney injury after transcatheter aortic valve implantation: insights from the Magna Graecia TAVI registry

“…Some studies, including a recent meta-analysis [4] [5], have suggested that the mechanism underlying AKI in this specific patient population is not necessarily related to contrast-induced nephropathy (CIN), but rather to other elements which may affect renal perfusion including baseline comorbidities, procedure-related and periprocedural factors. A number of studies have focused on the predictors of AKI after TAVI [5] [6] [7] [8] [9] [10] [11] [12], but less work has been carried regarding the effects of contrast medium (CM) amount and osmolality [13].…”

Increased mean perfusion pressure variability is associated with subsequent deterioration of renal function in critically ill patients with central venous pressure monitoring: a retrospective observational study

“…And for patients undergoing cardiac surgery, they presented with decreased perfusion pressure characterized by renal venous congestion [ 39 ]. The correlation between absolute level of MPP and the deterioration of renal function may be more significant [ 40 ]. After adjusting for TWA-MPP, the correlation between MPPV and the deterioration of renal function weakened.…”