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. 2012:2012:483748.
doi: 10.1155/2012/483748. Epub 2012 Dec 26.

The risk of acute kidney injury and its impact on 30-day and long-term mortality after transcatheter aortic valve implantation

Katrin Gebauer  1 , Gerhard-Paul Diller, Gerrit Kaleschke, Gregor Kerckhoff, Nasser Malyar, Matthias Meyborg, Holger Reinecke, Helmut Baumgartner
Affiliations

The risk of acute kidney injury and its impact on 30-day and long-term mortality after transcatheter aortic valve implantation

Katrin Gebauer et al. Int J Nephrol. 2012.

Abstract

Background. Transcatheter aortic valve implantation (TAVI) is widely used in high risk patients (pts) with aortic stenosis. Underlying chronic kidney disease implicates a high risk of postprocedural acute kidney injury (AKI). We analyzed its occurrence, impact on hospital stay, and mortality. Methods. 150 consecutive pts underwent TAVI in our institution (mean age 81 ± 7 years; logistic EuroSCORE 24 ± 15%). AKI definition was a creatinine rise of 26.5 μmol/L or more within 48 hours postprocedural. Ten patients on chronic hemodialysis were excluded. Results. AKI occurred in 28 pts (20%). Baseline creatinine was higher in AKI pts (126.4 ± 59.2 μmol/L versus 108.7 ± 45.1 μmol/L, P = 0.09). Contrast media use was distributed evenly. Both, 30-day mortality (29% versus 7%, P < 0.0001) and long-term mortality (43% versus 18%, P < 0.0001) were higher; hospital stay was longer in AKI pts (20 ± 12 versus 15 ± 10 days, P = 0.03). Predicted renal failure calculated STS Score was similar (8.0 ± 5.0% [AKI] versus 7.1 ± 4.0% [non-AKI], P = 0.32) and estimated lower renal failure rates than observed. Conclusion. AKI remains a frequent complication with increased mortality in TAVI pts. Careful identification of risk factors and development of more suitable risk scores are essential.

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Figures

Figure 1
Figure 1
Cumulative survival in pts. with (dotted lines) and without AKI (solid lines). (a) Crude cumulative survival (days) (HRR 2.7, CI 1.34–5.41, P < 0.01). (b) Adjusted cumulative survival (days) (HRR 3.8, CI 1.37–10.37, P = 0.01); adjusted for age, diabetes, PAD, hypertension, previous myocardial infarction and CABG, left ventricular function, amount of contrast dye, baseline creatinine, and hemoglobin.
Figure 2
Figure 2
Morbidity and mortality with respect to access site and development of acute kidney injury (AKI): observed 30-day mortality and predicted renal failure and mortality by STS Score for pts. with and without AKI; AKI = acute kidney injury.
See this image and copyright information in PMC

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