title: Incidence and effect of acute kidney injury after transcatheter aortic valve replacement using the new valve academic research consortium criteria.
abstract: Acute kidney injury (AKI) is associated with a poor prognosis after transcatheter aortic valve replacement (TAVR). A paucity of data exists regarding the incidence and effect of AKI after TAVR using the new recommended Valve Academic Research Consortium criteria. At Columbia University Medical Center, 218 TAVR procedures (64.2% transfemoral, 35.8% transapical) were performed from 2008 to July 2011. The creatinine level was evaluated daily until discharge. Using the Valve Academic Research Consortium definitions, the 30-day and 1-year outcomes were compared between patients with significant AKI (AKI stage 2 or 3) and those without significant AKI (AKI stage 0 or 1). Significant AKI occurred in 18 patients (8.3%). Of these 18 patients, 10 (55.6%) had AKI stage 3 and 9 (50%) required dialysis. AKI was associated with a lower baseline mean transvalvular gradient (37.6 ± 11.4 vs 45.6 ± 14.8 mm Hg for no AKI, p = 0.03). After TAVR, the AKI group had a greater hemoglobin decrease (3.6 ± 2.0 vs 2.4 ± 1.3 g/dl, p = 0.01), greater white blood cell elevation at 72 hours (21.09 ± 12.99 vs 13.18 ± 4.82 × 10(3)/μl, p = 0.001), a more severe platelet decrease (118 ± 40 vs 75 ± 43 × 10(3)/μl, p <0.0001), and longer hospitalization (10.7 ± 6.4 vs 7.7 ± 8.5 days, p <0.001). One stroke (5.6%) occurred in the AKI group compared with 3 (1.5%) in the group without AKI (p = 0.29). The 30-day and 1-year rates of death were significantly greater in the AKI group than in the no-AKI group (44.4% vs 3.0%, hazard ratio 18.1, 95% confidence interval 6.25 to 52.20, p <0.0001; and 55.6% vs 16.0%, hazard ratio 6.32, 95% confidence interval 3.06 to 13.10, p <0.0001, respectively). Periprocedural life-threatening bleeding was the strongest predictor of AKI after TAVR. In conclusion, the occurrence of AKI, as defined by the Valve Academic Research Consortium criteria, is associated with periprocedural complications and a poor prognosis after TAVR.
authors.affiliation: Columbia University Medical Center/New York-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA. pg2295@columbia.edu
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.forename: Susheel K
authors.initials: SK
authors.lastname: Kodali
authors.forename: Philip
authors.initials: P
authors.lastname: Green
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Paradis
authors.forename: Benoit
authors.initials: B
authors.lastname: Daneault
authors.forename: Garvey
authors.initials: G
authors.lastname: Rene
authors.forename: Irene
authors.initials: I
authors.lastname: Hueter
authors.forename: Isaac
authors.initials: I
authors.lastname: Georges
authors.forename: Ajay
authors.initials: A
authors.lastname: Kirtane
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Hahn
authors.forename: Craig
authors.initials: C
authors.lastname: Smith
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Williams
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology