Acute kidney injury may impede results after transcatheter aortic valve implantation

Incidence of Acute Kidney Injury Post Transcatheter Aortic Valve Implantation (TAVI): A Single-Center Experience

INTRODUCTION

Transcatheter aortic valve implantation (TAVI) has dramatically changed the approach to treating aortic stenosis, particularly for patients unsuitable for surgical aortic valve replacement. Nevertheless, the possibility of quick deterioration of kidney function, known as acute kidney injury (AKI), post operation is considered one of the complications.

OBJECTIVES

The study aimed to determine the incidence of AKI in adults post TAVI.

METHODS

This retrospective cohort study focuses on patients who underwent the TAVI procedure at the King Faisal Cardiac Center at the Ministry of National Guard Health Affairs (MNGHA) in Jeddah, Saudi Arabia, from May 2016 to December 2022. Acute kidney injury post TAVI was defined based on RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. Chi-square tests and independent sample t-tests were used to compare clinical and demographic characteristics between patients who developed AKI with those who did not, using an alpha of 5%.

RESULTS

The study involved 103 adult patients. Among them, 11 (10.7%) developed AKI post TAVI within seven days of the procedure, while 92 (89.3%) did not. Findings also revealed that patients with hyperlipidemia and a previous history of kidney diseases faced a higher risk of AKI post TAVI. Despite its valuable insights, the study has limitations due to its retrospective nature and small sample size.

CONCLUSIONS

The study emphasizes the importance of identifying patients with hyperlipidemia and pre-existing kidney conditions and closely monitoring renal function. While some preventive methods did not significantly impact AKI occurrences, further research is needed to refine preventive strategies.

Clinical Outcomes of Urgent or Emergency Transcatheter Aortic Valve Implantation - Insights From the Nationwide Registry of Japan Transcatheter Valve Therapies

BACKGROUND

Limited data are available for clinical outcomes in patients who underwent urgent or emergency transcatheter aortic valve implantation (TAVI). This study investigated in-hospital and 1-year outcomes and explored prognostic covariates in urgent/emergency TAVI using nationwide registry data.

METHODS AND RESULTS

Among 26,775 patients who underwent TAVI between August 2013 and December 2019, 25,495 with 1-year follow-up information were analyzed in this study. Baseline and procedural characteristics, as well as clinical adverse events, were compared between the urgent/emergency and elective TAVI groups. The primary outcome was all-cause mortality within 1 year after TAVI. Multivariable Cox regression models were constructed to identify independent predictors after urgent or emergency TAVI. Urgent or emergency TAVI was performed in 578 (2.3%) patients. The Society of Thoracic Surgeons score was significantly higher in the urgent/emergency than elective TAVI group (13.3% vs. 6.0%; P<0.001). Device success rate was comparable between the 2 groups. All-cause death-free survival within 1 year was lower in the urgent/emergency than elective TAVI group (77.2% vs. 92.2%; log rank P<0.001). Malignancy, albumin and creatinine concentrations, ejection fraction, and mean pressure gradient were associated with 1-year mortality in the urgent/emergency TAVI group.

CONCLUSIONS

Despite higher surgical risk and more comorbidities, the procedure was successfully performed in patients undergoing urgent/emergency TAVI, although it should be noted that prognosis was worse than for elective TAVI.

Prevalence and Risk Factors Associated With Acute Kidney Injury After Transcatheter Aortic Valve Replacement at a Tertiary Hospital in Riyadh, Saudi Arabia

BACKGROUND

Despite recent advancements in techniques, peri- and post-procedural complications still pose a significant challenge in the high-risk transcatheter aortic valve replacement (TAVR) patient population. This study aims to investigate and assess the prevalence of acute kidney injury (AKI) following TAVR, and to identify the risk factors associated with its occurrence.

METHODS

We conducted the study at King Abdulaziz Medical City, Riyadh, Saudi Arabia from January 2016 to December 2022. We extracted data from electronic medical records. We categorized and compared patients based on their diagnosis of AKI+ following TAVR, or their absence of AKI- after the procedure.

RESULTS

The study included a total of 344 patients who underwent TAVR. The mean age of the patients was 77.8 ± 8.9 years, 61.8% were male, and the average body mass index was 30.5±7.0. In terms of comorbidities, 70.8% of the patients had diabetes mellitus, 80.5% had hypertension, 8.7% had hypothyroidism, 2.0% had hematological disorders, 23.6% had congestive heart disease, 20.4% had cerebrovascular disease, 4.1% had peripheral vascular disease, 7.3% had cancer, and 34.4% had other comorbidities. The prevalence of AKI was 60 (17.50%) following the procedure. Cerebrovascular diseases showed a significant association with AKI (OR= 3.381, 95% CI, 1.65-6.91, p = 0.001). Chronic kidney disease has a significant effect on AKI (OR = 2.56, 95%CI, 1.02-6.39, p = 0.044). The creatinine level on Day 0 has a significant association with AKI (OR = 1.01, 95%CI, 1.006-1.017, p = 0.0001).

CONCLUSIONS

These findings highlight the importance of assessing and managing these risk factors (cerebrovascular diseases, chronic kidney disease, and creatinine level on Day 0) in TAVR patients to mitigate the occurrence and severity of AKI. By understanding and addressing these factors, healthcare providers can potentially improve patient outcomes and reduce the incidence of AKI-associated TAVR procedures.

One-Year and Five-Year Outcomes of Transcatheter Aortic Valve Replacement or Surgical Aortic Valve Replacement in a Taiwanese Elderly Population

BACKGROUND

The aim of our study was to provide real-world data on outcomes for elderly Taiwanese patients who underwent transcatheter aortic valve replacement or surgical aortic valve replacement in different risk groups.

METHODS

From March 2011 through December 2021, 177 patients with severe aortic stenosis who were ≥70 years old and had undergone TAVI (transcatheter aortic valve implantation) or SAVR (surgical aortic valve replacement) in a single center were divided by STS score (<4%, 4-8% and >8%) into three different groups. Then, we compared their clinical characteristics, operative complications, and all-cause mortality.

RESULTS

In all risk groups, there were no significant differences in in-hospital mortality, or 1-year and 5-year mortality between patients in the TAVI and SAVR groups. In all risk groups, patients in the TAVI group had shorter hospital stay and higher rate of paravalvular leakage than the SAVR group. After univariate analysis, BMI (body mass index) < 20 was a risk factor for higher 1-year and 5-year mortality. In the multivariate analysis, acute kidney injury was an independent factor for predicting worse outcomes in terms of 1-year and 5-year mortality.

CONCLUSIONS

Taiwan elderly patients in all risk groups did not have significant differences in mortality rates between the TAVI and the SAVR group. However, the TAVI group had shorter hospital stay and higher rate of paravalvular leakage in all risk groups.

NT-proBNP/urine hepcidin-25 ratio and cardiorenal syndrome type 1 in patients with severe symptomatic aortic stenosis

Background: This study aimed to determine whether novel and conventional cardiorenal biomarkers in patients before transcatheter aortic valve implantation may be associated with cardiorenal syndrome (CRS) type 1. Methods: Serum NT-proBNP and urine biomarkers (hepcidin-25, NGAL, IL-6) were measured before and 24 h after transcatheter aortic valve implantation. Results: 16/95 patients had CRS type 1. Those patients had longer length of stay in hospital (12.5 [9.0-16.0] vs 9.0 [8-12] days; p = 0.025) and were more frequently readmitted to hospital within 6 months after discharge (46.7 vs 15.6%; odds ratio: 4.7; 95% CI: 1.5-15.5; p = 0.007). The NT-proBNP/urine hepcidin-25 ratio (odds ratio: 2.89; 95% CI: 1.30-6.41; p = 0.009) was an independent modifier of CRS type 1. Conclusion: The NT-proBNP/urine hepcidin-25 ratio appears to be a modifier of risk of CRS type 1.

Risk of graft loss in kidney transplant recipients after aortic valve replacement

Surgical aortic valve replacement (SAVR) in kidney transplant recipients (KTR) is associated with high morbidity and mortality, and an increased risk of postoperative graft failure potentially leading to graft loss. Transcatheter aortic valve implantation (TAVI) emerged as an alternative in high-risk patients. However, data on TAVI in kidney transplant recipients are limited. We performed a retrospective analysis of 40 KTR in which aortic valve replacement was performed at our center between 2005 and 2015. The outcomes and follow-up of TAVI (n=20; 2010-2015) and SAVR (n=20; 2005-2015) were analyzed with respect to patient and graft survival. Baseline characteristics in both groups were comparable. Hospital stay after TAVI was significantly shorter compared to SAVR (19 [11.5-21.75] days vs. 33 [21-62] days, p=0.001). Acute graft failure occurred more frequently after SAVR (45% vs. 89.5%; p=0.006). Thirty-day mortality was 10% in both groups. However, in-hospital mortality reached 25% in the SAVR group (TAVI 10%), indicating a more complicated course after surgery. Moreover, during a median follow-up time of 1928 days in TAVI patients and 2717 days in patients after SAVR, graft loss occurred only in the surgically treated group (n=7). While one-year survival after TAVR was 90% compared to 69% after SAVR, long-term follow-up showed comparable results (at 5 years: TAVI 58% vs. 52% SAVR; log-rank-test: p=0.86). In KTR, TAVI can be performed with good mid- to long-term results. Compared to SAVR, renal outcomes seem to be improved after TAVI, suggesting better graft survival.

End-stage renal disease, calcification patterns and clinical outcomes after TAVI

BACKGROUND

Patients with chronic hemodialysis due to end-stage renal disease (ESRD) or severely impaired kidney function (CKD) constitute a relevant share of patients undergoing trans-catheter aortic valve implantation (TAVI). However, data on specific challenges and outcomes remain limited.

AIM

We aimed to characterize this patient population, evaluate clinical results and assess the significance of calcification patterns.

METHODS

This retrospective single-center analysis evaluated 2,712 TAVI procedures (2012-2019) according to baseline renal function: GFR < 30 ml/min/1.73m2 (CKD; n = 210), chronic hemodialysis (ESRD; n = 119) and control (CTRL; n = 2383). Valvular and vascular calcification patterns were assessed from contrast-enhanced multi-detector computed tomography. Outcomes were evaluated in accordance with the VARC-2 definitions.

RESULTS

Operative risk was higher in ESRD and CKD vs. CTRL (STS-score 8.4% and 7.6% vs. 3.9%, p < 0.001) and patients with ESRD had more severe vascular calcifications (49.1% vs. 33.9% and 29.0%, p < 0.01). Immediate procedural results were similar but non-procedure-related major/life-threatening bleeding was higher in ESRD and CKD (5.0% and 5.3% vs. 1.6%, p < 0.01). 3-year survival was impaired in patients with ESRD and CKD (33.3% and 35.3% vs. 65.4%, p < 0.001). Multivariable analysis identified ESRD (HR 1.60), CKD (HR 1.79) and vascular calcifications (HR 1.29) as predictors for 3-year and vascular calcifications (HR 1.51) for 30-day mortality.

CONCLUSION

Patients with ESRD and CKD constitute a vulnerable patient group with extensive vascular calcifications. Immediate procedural results were largely unaffected by renal impairment, yielding TAVI a particularly valuable treatment option in these high-risk operative patients. Mid-term survival was determined by underlying renal disease, cardiovascular comorbidities, and vascular calcifications as a novel risk marker.

Acute Kidney Injury after Transcatheter Aortic Valve Implantation

Aim. The aim of the study was to evaluate the incidence and predictors of acute kidney injury (AKI) associated with transcatheter aortic valve implantation (TAVI).

Material and methods. 50 patients (39 women, 11 men) aged 76 (71; 80) years who underwent TAVI were examined. One day after TAVI, blood creatinine level was determined by the Jaffe method and troponin I by a highly sensitive method (hs-cTnI). Acute kidney injury (AKI) was diagnosed according to the KDIGO criteria (2012). The following hospital complications were evaluated: cases of cardiac death, intraoperative myocardial infarction (MI), stroke and transient ischemic attack, permanent pacemaker implantation, recurrent paroxysms of atrial fibrillation.

Results. History of MI had 22% of patients, percutaneous coronary intervention – 38%, hypertension – 98%, chronic kidney disease – 48%, diabetes mellitus – 24%, class II NYHA of chronic heart failure (CHF) – 52%, NYHA class III – 46%, NYHA class IV – 2%. The risk of operational mortality according to EuroSCORE II was 6.3±5.4%. AKI after TAVI was registered in 6 (12%) patients (1 grade AKI – 8%, 2 grade – 2%, 3 grade – 2%). Parameters associated with AKI after TAVI were higher CHF NYHA class (p=0,020), high hs-cTnI level (p=0,013), intraoperative MI (p=0.035). The predictor of AKI after TAVI was high hs-cTnI level (odds ratio 4.0, 95% confidence interval 1.0-16.1). Among patients with AKI after TAVI in compare with patients without AKI, the cumulative frequency of cardiac death, MI, strokes and transient ischemic attacks, implantation of a permanent pacemaker, the proportion of people with paroxysmal atrial fibrillation during the hospital stay was 5,8 times higher (66.7% vs 11.4% respectively, p=0.001).

Conclusion. AKI after TAVI was present in 12% of patients. The predictor for AKI development was an increase in hs-cTnI level after TAVI implantation. The hospital prognosis after TAVI is worse in patients with postoperative AKI. 

Efficacy and Safety of Emergent Transcatheter Aortic Valve Implantation in Patients with Acute Decompensated Aortic Stenosis: Systematic Review and Meta-Analysis

Introduction

The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of emergent transcatheter aortic valve implantation (TAVI) in patients with decompensated aortic stenosis (AS) by comparing the clinical outcomes with the patients who had received the elective TAVI.

Methods

By searching PubMed, EMBASE, and Cochrane databases, we obtained the studies comparing the clinical outcomes of emergent TAVI and elective TAVI. Finally, 14 studies were included.

Results

A total of 14 eligible articles with 73,484 patients were included in this meta-analysis. Emergent TAVI was associated with a higher mortality during hospitalization (HR 2.09, 95% CI [1.39 to 3.14]), 30 days (HR 2.29, 95% CI [1.69 to 3.10]), and 1 year (HR 1.96, 95% CI [1.55 to 2.49]). Consistently, the incidence of acute kidney injury (AKI) (RR 2.48, 95% CI [1.85 to 3.32]), dialysis (RR 2.37, 95% CI [1.95 to 2.88]), bleeding (RR 1.62, 95% CI [1.27 to 2.08]), major bleeding (RR 1.05, 95% CI [1.00 to 1.10]), and 30-day rehospitalization (RR 1.30, 95% CI [1.07, 1.58]) were more common in patients receiving emergent TAVI. No statistical differences were found in the occurrence rate of vascular complications (RR 1.11, 95% CI [0.90, 1.36]), major vascular complications (RR 1.14, 95% CI [0.52, 2.52]), permanent pacemaker (PPM) placement (RR 1.05, 95% CI [0.99, 1.11]), cerebrovascular events (RR 1.11, 95% CI [0.98, 1.25]), moderate to severe paravalvular leakage (PVL) (RR 1.23, 95% [CI 0.94 to 1.61]), and device success (RR 0.99, 95% CI [0.97, 1.01]).

Conclusion

Emergent TAVI is associated with some postoperative complications and increased mortality compared with elective TAVI. Emergent TAVI should be implemented cautiously and individually.