Frequency, determinants, and prognostic effects of acute kidney injury and red blood cell transfusion in patients undergoing transcatheter aortic valve implantation.
OBJECTIVE
To determine the frequency and independent predictors of acute kidney injury (AKI) in addition to the prognostic implications of both AKI and periprocedural red blood cell (RBC) transfusions on 30 day and cumulative late mortality in patients undergoing transcatheter aortic valve implantation (TAVI).


BACKGROUND
RBC transfusions have been reported to predict AKI following TAVI. Data on the prognostic implications of both factors, however, are lacking.


METHODS
126 consecutive patients underwent TAVI with the Medtronic CoreValve Revalving System. AKI was defined according to the valve academic research consortium definitions as an absolute increase in serum creatinine ≥0.3 mg dL⁻¹ (≥26.4 μmol L⁻¹) or a percentage increase ≥ 50% within 72 hr following TAVI.


RESULTS
Five patients on chronic haemodialysis and three intraprocedural deaths were excluded, leading to a final study population of 118 patients. AKI occurred in 19% of the patients necessitating temporary haemodialysis in 2%. Independent predictors of AKI included: previous myocardial infarction (OR: 5.72; 95% CI: 1.64-19.94), periprocedural (<24 hr) RBC transfusions (OR: 1.29; 95% CI: 1.01-1.70), postprocedural (<72 hr) leucocyte count (OR: 1.18; 95% CI: 1.02-1.37), and logistic EuroSCORE (OR: 1.08; 95% CI: 1.01-1.14). In patients with AKI, 30-day mortality was 23% and cumulative late mortality (median: 13 months) was 55%. AKI (OR: 5.47; 95% CI: 1.23-24.21) and postprocedural leucocyte count (OR: 1.20; 95% CI: 1.03-1.38) were independent predictors of 30-day mortality while AKI (HR: 2.79; 95% CI: 1.36-5.71) was the only independent predictor of late mortality.


CONCLUSIONS
AKI following TAVI occurred in 19% of the patients. RBC transfusion was found to be an independent predictor of AKI, which in turn predicted both 30-day and cumulative late mortality.
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Rutger-Jan M
RJ
Nuis
Nicolas M
NM
Van Mieghem
Apostolos
A
Tzikas
Nicolo
N
Piazza
Amber M
AM
Otten
Jin
J
Cheng
Ron T
RT
van Domburg
Michiel
M
Betjes
Patrick W
PW
Serruys
Peter P T
PP
de Jaegere
D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000401:mortality; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D009426:Netherlands; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D003404:Creatinine