TY - JOUR
T1 - Acute Kidney Injury Following Transcatheter Aortic Valve Implantation—A Contemporary Perspective of Incidence, Predictors, and Outcomes
AU - Butala, Anant D.
AU - Nanayakkara, Shane
AU - Navani, Rohan V.
AU - Palmer, Sonny
AU - Noaman, Samer
AU - Haji, Kawa
AU - Htun, Nay M.
AU - Walton, Antony S.
AU - Stub, Dion
N1 - Funding Information:
Professor Stub’s research is supported by a National Heart Foundation of Australia and National Health and Medical Research Council Fellowship.
Funding Information:
We acknowledge the work of the Structural Heart Team study nurses at The Alfred Hospital who updated our TAVI database.
Publisher Copyright:
© 2023 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)
PY - 2024/3
Y1 - 2024/3
N2 - Background: Acute kidney injury (AKI) is a known complication following transcatheter aortic valve implantation (TAVI), associated with increased morbidity and mortality. Most of this data relates to higher-risk patients with early-generation TAVI valves. With TAVI now established as a safe and cost-effective procedure for low-risk patients, there is a distinct need for updated analysis. We aimed to assess the incidence, predictors, and outcomes of AKI in a contemporary cohort of TAVI patients, concurrently examining the role of temporal evolution on AKI. Method: A total of 2,564 patients undergoing TAVI from 2008–2023 included in the Alfred-Cabrini-Epworth (ACE) TAVI Registry were analysed. Patients were divided into AKI and no AKI groups. Outcomes were reported according to the Valve Academic Research Consortium-3 (VARC-3) criteria. Results: Of 2,564 patients, median age 83 (78–87) years, 57.4% men and a median Society of Thoracic Surgeons score of 3.6 (2.4–5.5), 163 (6.4%) patients developed AKI with incidence falling from 9.7% between 2008–2014 to 6% between 2015–2023 (p=0.022). On multivariable analysis, independent predictors of AKI were male sex (adjusted odds ratio [aOR] 1.89, p=0.005), congestive cardiac failure (aOR 1.52, p=0.048), estimated glomerular filtration rate 30–59 (aOR: 2.79, p<0.001), estimated glomerular filtration rate <30 (aOR 8.65, p<0.001), non-femoral access (aOR 5.35, p<0.001), contrast volume (aOR 1.01, p<0.001), self-expanding valve (aOR 1.60, p=0.045), and bleeding (aOR 2.88, p=0.005). Acute kidney injury was an independent predictor of 30-day (aOR: 6.07, p<0.001) and 12-month (aOR: 3.01, p=0.002) mortality, an association that remained consistent when excluding TAVIs performed prior to 2015. Conclusions: Acute kidney injury remains a relatively common complication of TAVI, associated with significant morbidity and mortality even in less comorbid, contemporary practice patients.
AB - Background: Acute kidney injury (AKI) is a known complication following transcatheter aortic valve implantation (TAVI), associated with increased morbidity and mortality. Most of this data relates to higher-risk patients with early-generation TAVI valves. With TAVI now established as a safe and cost-effective procedure for low-risk patients, there is a distinct need for updated analysis. We aimed to assess the incidence, predictors, and outcomes of AKI in a contemporary cohort of TAVI patients, concurrently examining the role of temporal evolution on AKI. Method: A total of 2,564 patients undergoing TAVI from 2008–2023 included in the Alfred-Cabrini-Epworth (ACE) TAVI Registry were analysed. Patients were divided into AKI and no AKI groups. Outcomes were reported according to the Valve Academic Research Consortium-3 (VARC-3) criteria. Results: Of 2,564 patients, median age 83 (78–87) years, 57.4% men and a median Society of Thoracic Surgeons score of 3.6 (2.4–5.5), 163 (6.4%) patients developed AKI with incidence falling from 9.7% between 2008–2014 to 6% between 2015–2023 (p=0.022). On multivariable analysis, independent predictors of AKI were male sex (adjusted odds ratio [aOR] 1.89, p=0.005), congestive cardiac failure (aOR 1.52, p=0.048), estimated glomerular filtration rate 30–59 (aOR: 2.79, p<0.001), estimated glomerular filtration rate <30 (aOR 8.65, p<0.001), non-femoral access (aOR 5.35, p<0.001), contrast volume (aOR 1.01, p<0.001), self-expanding valve (aOR 1.60, p=0.045), and bleeding (aOR 2.88, p=0.005). Acute kidney injury was an independent predictor of 30-day (aOR: 6.07, p<0.001) and 12-month (aOR: 3.01, p=0.002) mortality, an association that remained consistent when excluding TAVIs performed prior to 2015. Conclusions: Acute kidney injury remains a relatively common complication of TAVI, associated with significant morbidity and mortality even in less comorbid, contemporary practice patients.
KW - Aortic stenosis
KW - Contrast induced nephropathy
KW - Incidence
KW - Kidney injury
KW - TAVI
UR - https://www.scopus.com/pages/publications/85183558454
U2 - 10.1016/j.hlc.2023.11.018
DO - 10.1016/j.hlc.2023.11.018
M3 - Article
C2 - 38245395
AN - SCOPUS:85183558454
SN - 1443-9506
VL - 33
SP - 316
EP - 323
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
IS - 3
ER -