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Acute Kidney Injury After Transcatheter Aortic Valve Implantation: Incidence, Risk Factors, and Prognostic Effects

Alassar, Aiman MRCS; Roy, David MD; Abdulkareem, Nada PhD; Valencia, Oswaldo MD; Brecker, Stephen FRCP; Jahangiri, Marjan FRCS

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: November/December 2012 - Volume 7 - Issue 6 - p 389–393
doi: 10.1097/IMI.0b013e3182814e43
Original Articles

Objective Acute kidney injury (AKI) is a common complication after surgical aortic valve replacement and is associated with increased mortality. Transcatheter aortic valve implantation (TAVI) is now considered the criterion standard treatment of patients with severe symptomatic aortic stenosis ineligible for surgery. The aim of this study was to establish the incidence, risk factors, and prognostic consequences of AKI after TAVI and at 1-year follow-up in a single center.

Methods Between December 2007 and March 2011, a total of 79 patients with severe aortic stenosis who underwent 81 TAVI procedures with the Medtronic CoreValve System or the Edwards SAPIEN heart valve were included. Baseline characteristics and procedural complications were recorded. Acute kidney injury was defined according to the Valve Academic Research Consortium criteria (modified risk, injury, failure, loss, and end-stage kidney disease criteria).

Results The mean age was 84 (78–87) years; 49 were men. After TAVI, 10 patients (12.3%) developed AKI, which had completely resolved in 9 patients before hospital discharge. Nine patients (10%) had mild AKI (stage 1) and only one patient (10%) experienced moderate AKI (stage 2) according to Valve Academic Research Consortium definitions. The predictive factors of AKI were diabetes (odds ratio, 6.722; P = 0.004) and preoperative creatinine level greater than 104 μmol/L (odds ratio, 1.024; P = 0.02). Thirteen patients (16.4%) died within 1 year after TAVI. Three of the nonsurvivors (3.7%) developed AKI postoperatively. Acute kidney injury was, however, not a predictive factor of 1-year mortality after TAVI.

Conclusions Acute kidney injury occurred in 12.3% of the patients after TAVI and persisted in only one patient before hospital discharge. Diabetes and preoperative creatinine level were found to be the main predictive factors of AKI after TAVI. Acute kidney injury was not associated with increased 1-year mortality.

From the Department of Cardiology and Cardiac Surgery, St. George’s Hospital, London, England.

Accepted for publication November 26, 2012.

Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, May 30 – June 2, 2012, Los Angeles, CA USA.

Disclosures: Stephen Brecker, FRCP, is a consultant to Medtronic, Inc, Minneapolis, MN USA. Aiman Alassar, MD; David Roy, MD; Nada Abdulkareem, MD; Oswaldo Valencia, MD; and Marjan Jahangiri, FRCS, declare no conflict of interest.

Address correspondence and reprint requests to Marjan Jahangiri, FRCS, Department of Cardiac Surgery, St. George’s Hospital, Blackshaw Rd, London SW17 0QT England. E-mail: marjan.jahangiri@stgeorges.nhs.uk.

Copyright © 2012 by the International Society for Minimally Invasive Cardiothoracic Surgery. Unauthorized reproduction of this article is prohibited.