Abstract 4435: Acute Kidney Injury Following Transcatheter Aortic Valve Implantation: Predictive Factors, Prognostic Value, and Comparison With Surgical Aortic Valve Replacement
Background: 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
to determine the incidence, predictive factors and prognostic value of AKI following TAVI, and
to compare the occurrence of AKI in TAVI versus surgical aortic valve replacement (SAVR) in patients with baseline chronic kidney disease (CKD).
Methods and Results: A total of 213 patients (mean age 82±8 years, mean logistic EuroSCORE 29.3±17.5) undergoing TAVI for the treatment of severe aortic stenosis were included in the study. AKI was defined as a reduction of >25% in estimated glomerular filtration rate (eGFR) within 48 hrs following the procedure or the need for dialysis during index hospitalization. Those patients with CKD (eGFR <60 ml/min/1.73 m2, n=119) were compared with 245 contemporary patients with CKD who underwent isolated SAVR. The incidence of AKI following TAVI was 11.7%, with 1.4% of the patients requiring dialysis. Predictive factors of AKI were hypertension (OR: 4.66; 95% CI: 1.04 to 22.87; P=0.044), chronic obstructive pulmonary disease (OR: 2.64, 95% CI: 1.10 to 6.36, P=0.030), and need for perioperative blood transfusion (OR: 3.47, 95% CI: 1.30 to 9.29; P=0.013). 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 to 1.06; P=0.009) and occurrence of AKI (OR: 4.49, 95% CI: 1.39 to 14.48; P=0.009) 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 to those who underwent SAVR (P<0.0001 for all). The incidence of AKI was lower (P=0.021) in CKD patients who underwent TAVI (9.2%, need for dialysis 2.5%) compared to those who underwent SAVR (18.8%, need for dialysis: 4.9%).
Conclusions. AKI occurred in 11.7% of the patients following TAVI and was associated with a >4-fold increase in 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 to SAVR.