title: Acute kidney injury after transcatheter aortic valve implantation with self-expanding CoreValve prosthesis: results from a large multicentre Italian research project.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) can be associated with varying degrees of new renal impairment. The aim of this multicentre analysis was to determine the impact and predictors of periprocedural acute kidney injury (AKI) on prognosis after TAVI.
  
  
  RESULTS
  From the ClinicalService (a nation-based data repository and medical care project) dataset, 1,157 patients with severe aortic stenosis treated with the third-generation CoreValve prosthesis in seven Italian sites, and with creatinine data available at baseline and during the post-TAVI in-hospital course, were included in this analysis. All outcomes were defined according to the VARC criteria. Overall, AKI occurred in 231 (20.0%): 15.4% stage 1, 2.7% stage 2, and 1.9% stage 3. Compared to patients without AKI, patients who suffered post-procedural AKI had significantly higher three-year all-cause mortality (31% vs. 12%; adjusted HR: 2.09; 95% CI: 1.52-2.87, p<0.001) and cardiovascular mortality (14% vs. 6%; adjusted HR: 2.28; 95% CI: 1.41-3.71, p=0.001). No significant differences in terms of stroke, spontaneous MI, and bleeding were reported. Female gender (adjusted OR: 1.37, 95% CI: 1.01-1.87; p=0.045), baseline renal insufficiency (adjusted OR: 11.02, 95% CI: 5.12-23.73; p<0.001), general anaesthesia (adjusted OR: 1.37, 95% CI: 1.00-1.87; p=0.050), and transfusion ≥3 red blood cell (RBC) units within 72 hrs from TAVI (adjusted OR: 1.65, 95% CI: 1.02-2.68; p=0.041) were found to be independent predictors of AKI.
  
  
  CONCLUSIONS
  Acute kidney injury is a frequent complication and significantly impacts on both early and long-term TAVI survival. Females, subjects with impaired renal function at baseline, patients undergoing TAVI under general anaesthesia, and patients receiving ≥3 RBC units after the procedure should be considered populations at high risk for the development of AKI after TAVI.
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Carmelo
authors.initials: C
authors.lastname: Sgroi
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.forename: Federico
authors.initials: F
authors.lastname: De Marco
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Poli
authors.forename: Diego
authors.initials: D
authors.lastname: Maffeo
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Patrizia
authors.initials: P
authors.lastname: Aruta
authors.forename: Simona
authors.initials: S
authors.lastname: Gulino
authors.forename: Alessandra
authors.initials: A
authors.lastname: Giarratana
authors.forename: Martina
authors.initials: M
authors.lastname: Patanè
authors.forename: Stefano
authors.initials: S
authors.lastname: Cannata
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Immè
authors.forename: Lorenza
authors.initials: L
authors.lastname: Mangoni
authors.forename: Agnese
authors.initials: A
authors.lastname: Rossi
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000706:statistics & numerical data; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D004452:Echocardiography; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012737:Sex Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome