Transapical versus transfemoral approach and risk of acute kidney injury following transcatheter aortic valve replacement: a propensity-adjusted analysis

Abstract

Background: The aim of this study was to compare the incidence of post-procedural acute kidney injury (AKI) and other renal outcomes in patients undergoing transapical (TA) and transfemoral (TF) approaches for transcatheter aortic valve replacement (TAVR).Methods: All consecutive adult patients undergoing TAVR for aortic stenosis from 1 January 2008 to 30 June 2014 at a tertiary referral hospital were included. AKI was defined based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression adjustment, propensity score stratification, and propensity matching were performed to assess the independent association between procedural approach and AKI.Results: Of 366 included patients, 171 (47%) underwent TAVR via a TA approach. AKI occurrence in this group was significantly higher compared to the TF group (38% vs. 18%, p < .01). The TA approach remained significantly associated with increased risk of AKI after logistic regression (OR 3.20; CI 1.68–4.36) and propensity score adjustment: OR 2.83 (CI 1.66–4.80) for stratification and 3.82 (CI 2.04–7.44) for matching. Nonetheless, there was no statistically significant difference among the TA and TF groups with respect to major adverse kidney events (MAKE) or estimated glomerular filtration rate (eGFR) at six months post-procedure.Conclusion: In a cohort of patients undergoing TAVR for aortic stenosis, a TA approach significantly increases the AKI risk compared with a TF approach. However, the TAVR approach did not affect severe renal outcomes or long-term renal function.

Persistent acute kidney injury following transcatheter aortic valve replacement

“…Diabetes mellitus, prior PCI, use of IABP, and need for blood transfusion were independently associated pAKI risk factors. While the transapical approach has been shown to increase TAVR‐related AKI when compared with the transfemoral approach, it has not been correlated with severe or long‐term renal dysfunction . We did not find any association between the different TAVR approaches with pAKI or its outcomes.…”

“…Previous studies, including a very recent study by Aalaei‐Andabili et al, have identified important predictive factors for AKI after TAVR, including pre‐existing chronic kidney disease, diabetes mellitus, use of the transapical approach, need for circulatory support, peripheral artery disease, prior coronary artery bypass grafting, and periprocedural blood transfusion, suggesting close surveillance for AKI especially within 7 days after TAVR in these high‐risk populations . In the present study, we investigated potential risk factors for pAKI after TAVR.…”

“…Although prevention and management of overall AKI after TAVR is crucial, if pAKI were known to also be significantly predictive of worse outcomes specifically after TAVR, this knowledge could allow further targeting of high‐risk pAKI patients for a multidisciplinary approach with treatment modification and closer clinical follow‐up to improve outcomes. Risk factors for overall AKI after TAVR have been identified recently, including preexisting chronic kidney disease, transapical approach, need for circulatory support, and periprocedural blood transfusion . However, the incidence and risk factors for pAKI after TAVR are currently not known.…”

Changes in kidney function among patients undergoing transcatheter aortic valve replacement

“…Transcatheter aortic valve replacement (TAVR) has globally expanded in the past decade and now is acknowledged as a standard approach for patients who have severe aortic stenosis (AS) deemed inoperable with high surgical risk for open-heart aortic valve replacement surgery (1)(2)(3)(4)(5)(6). In addition, the recently published studies also suggest that patient selection for TAVR is evolving toward treating lower surgical risk patients (7)(8)(9).…”

Greetings to the readers

“…Over the last couple of years, we have seen the Journal publish highly impactful papers on a wealth of issues, including meta-analyses on the link between proton-pump inhibitors and hypomagnesemia [1], on the impact of overhydrated status and low lean tissue in end-stage renal disease (ESRD) patients [2], on uric acid lowering therapy and chronic kidney disease progression [3] and a systemic review and meta-analysis further confirming cinacalcet's lack of impact on survival in (ESRD) patients [4]. Single-center studies published in the Journal have explored the impact of AKI in donors on renal graft survival subsequent to renal transplantation [5], the risk of AKI after transcatheter aortic valve placement [6] and quality of life, as well as the correlation of personality profiles and coping styles with clinical outcomes in ESRD patients on maintenance hemodialysis [7]. Additional publications in the Journal have also explored the frequency and clinical characteristics of invasive fungal infections in renal transplant recipients [8], the value of combination biomarkers in predicting renal impairment after a cardiovascular bypass procedure [9], the clinical characteristics of sepsis-induced AKI from China [10], post-partum renal injury from India [11] outcomes and characteristics of AKI in hospitalized patients from sub-Saharan Africa.…”