Impact of postoperative acute kidney injury on clinical outcomes after transcatheter aortic valve implantation: A meta‐analysis of 5,971 patients

Gargiulo, Giuseppe; Sannino, Anna; Capodanno, Davide; Perrino, Cinzia; Capranzano, Piera; Barbanti, Marco; Stabile, Eugenio; Trimarco, Bruno; Tamburino, Corrado; Esposito, Giovanni

doi:10.1002/ccd.25867

Cited by 85 publications

(74 citation statements)

References 40 publications

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“…PARTNER, PARTNER 2A, and SURTAVI trials showed a marked lower rate of AKI in TAVR compared to SAVR at 30-day follow-up (1.3 vs. 3.1, P=0.006; 6 vs. 15.1, P<0.001 and 1.7 vs. 4.4, 95% CI: −4.4 to −1.0 respectively) that was maintained at 1 and 2-year follow-up (13,14,19). A metaanalysis confirmed the importance of AKI on survival, showing that patients with AKI have a 5-fold increase in 30-day mortality and 3-fold increase at 1-year post TAVR (51). In a propensity score analysis with SAVR, TAVR with Sapien 3 in intermediate risk patients showed 6-fold reduction in AKI (0.5% vs. 3.3%), a similar rate of major vascular complications (6.1% vs. 5.4%) and a strong difference in life-threatening/ disabling bleeding (4.6 vs. 46.7) and cardiac death (0.9% vs. 3.1%) (52).…”

Section: Bleeding and Acute Kidney Injury (Aki)supporting

confidence: 52%

Pros and cons of transcatheter aortic valve implantation (TAVI)

Terre¹,

George²,

Smith³

2017

ASVIDE

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Transcatheter aortic valve implantation (TAVI) or replacement (TAVR) was recently approved by the FDA for intermediate risk patients with severe aortic stenosis (AS). This technique was already worldwide adopted for inoperable and high-risk patients. Improved device technology, imaging analysis and operator expertise has reduced the initial worrisome higher complications rate associated with TAVR, making it comparable to surgical aortic valve replacement (SAVR). However, many answers need to be addressed before adoption in lower risk patients. This paper highlights the pros and cons of TAVI based mostly on randomized clinical trials involving the two device platforms approved in the United States. We focused our analysis on metrics that will play a key role in expanding TAVR indication in healthier individuals. We review the significance and gave a perspective on paravalvular leak (PVL), valve performance, valve durability, leaflet thrombosis, stroke and pacemaker requirement.

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Section: Bleeding and Acute Kidney Injury (Aki)supporting

confidence: 52%

Pros and cons of transcatheter aortic valve implantation (TAVI)

Terre¹,

George²,

Smith³

2017

ASVIDE

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“…AKI remains a common complication immediately after transcatheter aortic valve implantation (TAVI), however, its detection varied considerably depending on the definition used . This complication is likely the combination of contrast‐induced nephrotoxicity (CIN), microembolization of atherosclerotic plaque debris due to delivery of large devices in the aorta, and/or hypotension in an individual with abnormal baseline renal function/reserve .…”

mentioning

confidence: 99%

Acute kidney injury after TAVI: Predict, detect, and prevent

Belardi

Albertal

2016

Cathet Cardio Intervent

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Acute kidney injury (AKI) is frequently observed immediately after transcatheter aortic valve implantation (TAVI). Both classifications, the RIFLE (the Risk, Injury, Failure, Loss, and End-stage Kidney) and the KDIGO (Kidney Disease: Improving Global Outcomes) from the VARC-2 (Valve Academic Research Consortium-2) are fairly interchangeable and performed well as clinical predictors of all-cause mortality. Patients with baseline reduced glomerular filtration rate (GFR) or known atherosclerotic arterial disease are at increased risk of AKI.

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“…Acute kidney injury should be promptly diagnosed and treated, nephrotoxic drugs should be stopped, and patients whom will benefit from renal replacement therapy should be identified. 22 The usefulness of renal protection devices (e.g., Renal guard; RenalGuard Solutions, Inc., Milford, Massachusetts) is currently at most uncertain. 23 Female gender has been found to be a positive predictor for survival in some TAVI cohorts and neutral in others.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes for Patients With Severe Symptomatic Aortic Stenosis Treated With Transcatheter Aortic Valve Implantation

Codner

Orvin

Assali

et al. 2015

The American Journal of Cardiology

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Transcatheter aortic valve implantation (TAVI) is an established technique for the treatment of severe symptomatic aortic stenosis. Data on long-term TAVI outcomes, both hemodynamic and clinical, in real-world practice settings are limited. We aim to explore the long-term clinical results in patients with severe symptomatic aortic stenosis using multiple catheter-based options: 360 TAVI-treated patients were followed up for ≤5 years. The Medtronic CoreValve was used in 71% and the Edwards SAPIEN in 26%. The primary end point was all-cause mortality during follow-up. Outcomes were assessed based on the Valve Academic Research Consortium 2 criteria. The mean ± SD patient age was 82.1 ± 6.9 years (56.4% women). The Society of Thoracic Surgeons score was 7.5 ± 4.7. The clinical efficacy end point and time-related valve safety at 3 years was 50% and 81.7%, respectively. The calculated 3- and 5-year survival rates were 71.6% and 56.4%, respectively. Five-year follow-up data were obtained for 54 patients alive; 96.2% of alive patients were in the New York Heart Association class I and II, 4 years after TAVI. No gender differences in all-cause mortality rates were observed (p = 0.58). In multivariate analysis, hospitalization 6 months previous to TAVI (hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.17 to 3.15, p = 0.01), frailty (HR 1.89, 95% CI 1.11 to 3.2, p = 0.02), acute kidney injury (HR 1.93, 95% CI 1.03 to 3.61, p = 0.04), and moderate or more paravalvular aortic regurgitation after TAVI (HR 4.26, 95% CI 2.54 to 7.15, p <0.001) were independent predictors for all-cause mortality. In conclusion, long-term outcomes of TAVI are encouraging. Prevention and early identification of paravalvular leak and acute renal failure after the procedure would improve short- and long-term outcomes.

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Impact of postoperative acute kidney injury on clinical outcomes after transcatheter aortic valve implantation: A meta‐analysis of 5,971 patients

Abstract: Postoperative AKI seems to significantly worsen TAVI prognosis. The results of the present meta-analysis should be considered hypothesis-generating and future studies on risk stratification, prevention, and postoperative management are needed.

Cited by 85 publications

References 40 publications

Pros and cons of transcatheter aortic valve implantation (TAVI)

Pros and cons of transcatheter aortic valve implantation (TAVI)

Acute kidney injury after TAVI: Predict, detect, and prevent

Long-Term Outcomes for Patients With Severe Symptomatic Aortic Stenosis Treated With Transcatheter Aortic Valve Implantation

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