Zero To Hero? Reducing The Rate of Acute Kidney Injury in Transcatheter Aortic Valve Replacement: The Low Contrast Approach

Abstract

Background: Acute kidney injury is a complication after transcatheter aortic valve replacement (TAVR) that increases hospital stay, morbidity, and mortality; moreover, the amount of contrast has been linked to acute kidney injury. Reducing the contrast during TAVR is hypothesized to decrease acute kidney injury without compromising outcomes. Methods: A single-institution retrospective analysis was performed on patients undergoing TAVR from 2017 to 2019. Patients with 20 mL or less of contrast were labeled as group I, and patients with more than 20mL of contrast were labeled as group II. Primary endpoints were 30-day mortality, acute kidney injury, and early aortic regurgitation. Results: Between 2017 and 2019, 597 patients underwent TAVR, of which 594 met the inclusion and exclusion criteria. Four hundred twenty-nine (71%) patients were included in group I, and 165 (29%) were included in group II. Two hundred eight patients (51%) and 41 patients (24.6%) from group I and group II had chronic kidney disease stage III or IV. The mean contrast volume was 8.5mL (± 6) for group I and 33mL (± 16) for group II (p<0.001).Thirteen patients (3%) from group I had acute kidney injury; six (1.5%) required hemodialysis. In group II, nine (5.5%) patients had acute kidney injury (p=0.146); one required hemodialysis (p=0.435). Of all, 579 (97%) had less than moderate aortic regurgitation in the postoperative echocardiogram. Conclusion: Low contrast TAVR is safe and effective and can reduce the incidence of acute kidney injury without affecting outcomes such as death, aortic regurgitation, and the need for a permanent pacemaker.