Acute Kidney Injury Following Transcatheter Aortic Valve Implantation: Predictive Factors, Prognostic Value, and Comparison with Surgical Aortic Valve Replacement

OBJECTIVES: Very 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: A 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.

RESULTS: Those patients with pre-procedural CKD (eGFR <60 mL/min/1.73 m(2), 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%).

CONCLUSION: Acute 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. Benjamin Watson Jersey

PMID: 20037180

Posted in Invasive Imaging and tagged , , , , , , .

2 Comments

  1. Interestingly, the data does not show the use of contrast media influenced acute renal injury.
    The authors are elsewhere quoted, saying that the low mean contrast volume used in the study (100 mL); “might at least partially explain this finding; this was a two-center study, and we both made strenuous efforts to minimize our use of contrast media.”

    See also post from December 19th:
    Ultra-Low-Dose Intra-Arterial Contrast Injection for Iliofemoral Computed Tomographic Angiography.
    Subodh B. Joshi, Dorinna D. Mendoza, Daniel H. Steinberg, Matthew A. Goldstein, Cristian F. Lopez, Arnold Raizon, Gaby Weissma, Lowell F. Satler, Augusto D. Pichard, Wm. Guy Weigold.

  2. Interestingly, as per this study, the predictive factors for the occurrence of TAVI were a history of hypertension (expected), COPD (not necessarily expected), the need for more frequent blood transfusions during the peri-procedural period (expected), and the use of a trans-apical approach (interesting).
    The results are significant clinically as the authors showed the greater hospital mortality in patients with AKI. Should the percutaneous approach be considered the new standard for patients at risk of AKI?

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