scholarly journals The Risk of Acute Kidney Injury and Its Impact on 30-Day and Long-Term Mortality after Transcatheter Aortic Valve Implantation

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Katrin Gebauer ◽  
Gerhard-Paul Diller ◽  
Gerrit Kaleschke ◽  
Gregor Kerckhoff ◽  
Nasser Malyar ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
High Risk ◽  
Aortic Valve ◽  
Kidney Injury ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Long Term Mortality

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 age81 ± 7years; logistic EuroSCORE24 ± 15%). AKI definition was a creatinine rise of26.5 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.

Forced diuresis with matched hydration during transcatheter aortic valve implantation for Reducing Acute Kidney Injury: a randomized, sham-controlled study (REDUCE-AKI)

2019 ◽  
Vol 40 (38) ◽  
pp. 3169-3178 ◽  
Author(s):  
Yaron Arbel ◽  
Eyal Ben-Assa ◽  
Daniela Puzhevsky ◽  
Batia Litmanowicz ◽  
Naama Galli ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Kidney Injury ◽  
Transcatheter Aortic Valve ◽  
Forced Diuresis ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Long Term Mortality

Abstract Aims Acute kidney injury (AKI) is a common complication following transcatheter aortic valve implantation (TAVI) and is associated with increased risk for short- and long-term mortality. In patients undergoing percutaneous coronary intervention (PCI), forced diuresis with matched hydration has been shown to reduce the incidence of AKI by ∼50%. The aim of the present study was to evaluate whether forced diuresis with matched intravenous hydration reduces AKI in patients undergoing TAVI. Methods and results Reducing Acute Kidney Injury (REDUCE-AKI) was a single-centre, prospective, randomized, double-blind sham-controlled clinical trial, designed to examine the effect of an automated matched saline infusion with urine output for the prevention of AKI in patients undergoing TAVI. A total of 136 TAVI patients were randomized, 68 in each group. Mean age was 83.9 ± 5 years and 41.2% were males. There were no differences in baseline characteristics between the two groups. The rate of AKI was not statistically different between the groups (25% in the active group vs. 19.1% in the sham group, P = 0.408). There was a significant increase in long-term mortality in the active group (27.9% vs. 13. 2% HR 3.744, 95% CI 1.51–9.28; P = 0.004). The study was terminated prematurely by the Data Safety Monitoring Board for futility and a possible signal of harm. Conclusions Unlike in PCI, forced diuresis with matched hydration does not prevent AKI in patients undergoing TAVI, and might be associated with increased long-term mortality. Future studies should focus on understanding the mechanisms behind these findings. Clinicaltrials.gov registration NCT01866800, 30 April 2013.

Acute kidney injury after transcatheter aortic valve implantation and mortality risk—long-term follow-up

2018 ◽  
Vol 35 (3) ◽  
pp. 433-438 ◽  
Author(s):  
Orit Kliuk-Ben Bassat ◽  
Ariel Finkelstein ◽  
Samuel Bazan ◽  
Amir Halkin ◽  
Itzhak Herz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Valve ◽  
Mortality Risk ◽  
Kidney Injury ◽  
Transcatheter Aortic Valve ◽  
Long Term Follow Up ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Acute kidney injury (AKI) complicating transcatheter aortic valve implantation (TAVI) is relatively frequent and associated with significant morbidity. Previous studies have shown a higher 30-day and 1-year mortality risk in patients with periprocedural AKI. Our aim was to identify the prognostic impact of periprocedural AKI on long-term follow-up. Methods This is a single-center prospective study evaluating patients undergoing TAVI for severe aortic stenosis. AKI was defined according to the Valve Academic Research Consortium 2 definition, as an absolute increase in serum creatinine ≥0.3 mg/dL or an increase &gt;50% within the first week following TAVI. Mortality data were compared between patients who developed AKI and those who did not. Logistic and Cox regressions were used for survival analysis. Results The final analysis included 1086 consecutive TAVI patients. AKI occurred in 201 patients (18.5%). During the follow-up period, 289 patients died. AKI was associated with an increased risk of 30-day mortality {4.5 versus 1.9% in the non-AKI group; hazard ratio [HR] 3.70 [95% confidence interval (CI) 1.35–10.13]}. Although 1-year mortality was higher in the AKI group in univariate analysis, it was not significant after a multivariate regression. AKI was a strong predictor of longer-term mortality [42.3 versus 22.7% for 7-year mortality; HR 1.71 (95% CI 1.30–2.25)]. In 189 of 201 patients we had data regarding recovery from AKI up to 30 days after discharge. In patients with recovery from AKI, the mortality rate was lower (38.2 versus 56.6% in the nonrecovery group; P = 0.022). Conclusions Periprocedural AKI following TAVI is a strong risk factor for short-term as well as long-term mortality (up to 7 years). Therefore more effort is needed to reduce this complication.

scholarly journals Clinical impact of acute kidney injury on short- and long-term outcomes after transcatheter aortic valve implantation with the CoreValve prosthesis

2015 ◽  
Vol 66 (1) ◽  
pp. 46-49 ◽  
Author(s):  
Antonio J. Muñoz-García ◽  
Erika Muñoz-García ◽  
Manuel F. Jiménez-Navarro ◽  
Antonio J. Domínguez-Franco ◽  
Juan H. Alonso-Briales ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Valve ◽  
Kidney Injury ◽  
Clinical Impact ◽  
Long Term Outcomes ◽  
Transcatheter Aortic Valve ◽  
Short And Long Term ◽  
Aortic Valve Implantation ◽  
Valve Implantation
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