Introduction:
The presence of acute renal injury (AKI) enhances morbimortality after surgical aortic valve.
Hypothesis:
This prospective observational study aims to determine the incidence of AKI after transcatheter aortic valve replacement (TAVR), its predictors and impact on 30-days and 1-year mortality.
Methods:
We assessed data from 224 consecutive patients with severe symptomatic aortic stenosis submitted to TAVR between January 2009 and February 2015 on two tertiary cardiologic centers, conducted by the same heart team. All patients used an ionic, low-osmolar, low-viscosity contrast. Kidney injury was defined according to VARC criteria, following AKIN system, and data collected until the seventh day post-procedure. Three patients were excluded due to death during the procedure, considering those deaths not related to renal dysfunction, remaining 221 patients analysed separated in two groups: AKI group and non-AKI group. Follow-up was performed on 30 days and after one year.
Results:
Fifty two patients (23.5%) developed AKI until seventh day of procedure. Groups 1 and 2 were similar, except for EuroSCORE II (8.66% ± 5.64% vs 7.34% ± 8.58%, p = 0.02) and glomerular filtration rate (GFR) (39.59 ml/min.1.73m2 ± 13.62 vs. 48.49 ± 19.6, p = 0.002). Overall 30 days-mortality and 1-year mortality was 6.3% and 14.0%, respectively. Both 30-day mortality (23.1% vs 1.2%, p < 0.001) and 1-year mortality (44.2% vs 4.7%, p< 0.001) were higher in group 1. In multivariable-adjusted models, the only independent predictor for AKI after TAVR was baseline GFR [hazard ratio (HR) 1.37, CI 95% 1.08-1.77, p = 0.01]. Regarding long term follow-up, AKI (HR 19.86, CI 95% 7.31-53.98, p <0.001) and COPD (HR 3.14, CI 95% 1.05-9.40, p = 0.04) were independent risk factors for 1-year mortality, whilst hypertension (HR 0.269, CI 95% 0.09-0.80, p = 0.01) was shown to be protective for long term mortality.
Conclusion:
In this TAVR sample, baseline GFR was the only independent predictor of AKI, and patients who developed it had significantly higher mortality at 30 days and 1 year. Acute renal impairment was the strongest risk factor for mortality and adverse cardiovascular events that provided risk information beyond the traditional scores, as EuroSCORE II and STS.
TCT-224 Gastrointestinal Bleed Pre-Transcatheter Aortic Valve Replacement: An Independent Predictor of Mortality
