Incidence and risk factors of acute kidney injury following transcatheter aortic valve replacement

Abstract

In a cohort of patients undergoing TAVR for aortic stenosis, AKI commonly occurred and was significantly associated with increased mortality. Baseline renal function, procedure approach and the need for circulatory support were important predictive factors for post-procedural AKI occurrence.

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

“…Intra-operative factors consistently shown to be independently associated with AKI in several studies include a transapical approach for TAVR 112 and need for red blood cell (RBC) transfusion. 100 Small observational studies, and a recent large cohort-study confirmed that TAVR via a transapical approach is associated with 4.7-9.3 times higher risk for AKI when compared to the transfemoral approach.…”

“…113 This was elegantly shown by Thongprayoon et al; in patients undergoing the transapical approach for TAVR, PVD was more prevalent than those undergoing transfemoral approach (73% vs 44%; p<0.001). 112 .Patients with advanced PVD have a larger atherosclerotic burden that puts them at a higher risk of distal embolic events from the dislodgement of the plaque to the kidney during instrumentation of the aorta. An alternative explanation might be that since general anesthesia is needed during the transapical approach, this may be associated with higher rates of hemodynamic or nephrotoxic insult to the kidney 112 …”

“…119 Finally, atherosclerosis is common in the majority of patients undergoing TAVR. 112 Calcification of the aorta and use of a transapical approach can put the patient at risk of distal cholesterol emboli to the renal vascular bed especially during catheter manipulation in the aorta.…”

“…100 Small observational studies, and a recent large cohort-study confirmed that TAVR via a transapical approach is associated with 4.7-9.3 times higher risk for AKI when compared to the transfemoral approach. 95,98,112 Patients who undergo a transapical approach usually have severe atherosclerotic disease that precludes them from transfemoral access. 113 This was elegantly shown by Thongprayoon et al; in patients undergoing the transapical approach for TAVR, PVD was more prevalent than those undergoing transfemoral approach (73% vs 44%; p<0.001).…”

Changes in kidney function among patients undergoing transcatheter aortic valve replacement

“…Thus, to date, more than 200 000 TAVR procedures have been performed worldwide (3,10). Despite increasing evidence of treating intermediate surgical-risk patients (7)(8)(9), many patients elected for TAVR commonly have renal insufficiency (11,12), one of important predictors for acute kidney injury (AKI) development (13). In addition, AKI following TAVR is very prevalent, varying from 15% up to 57% (10,11,(14)(15)(16).…”