title: Prognostic Usefulness of Acute Kidney Injury After Transcatheter Aortic Valve Replacement.
abstract: Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) has been associated with increased postoperative morbidity and mortality. Long-term outcomes after TAVR with the Edwards SAPIEN valve in patients who develop AKI postoperatively are currently not well described. We retrospectively reviewed 384 consecutive patients undergoing TAVR at 2 institutions from August 2006 to April 2012. AKI was defined and staged according to Valve Academic Research Consortium-2 criteria. The incidence, multivariate predictors, and association of AKI with 3-year mortality were evaluated. Stage 1 AKI occurred in 24.0% of patients (92 of 384), stage 2 in 5.5% (21 of 384), and stage 3 in 8.1% (31 of 384). The overall operative mortality rate was 7.6%, with a mortality of 3.0% in patients with no kidney injury, 7.6% in stage 1, 23.8% in stage 2, and 32.3% in stage 3. The incidence of new postoperative dialysis was 3.1%. Survival at 3 years for no-AKI/stage 1/stage 2/stage 3 was 59.2 ± 3.3%, 43.4 ± 5.2%, 27.8 ± 10.0%, and 25.4 ± 7.9%, respectively. Logistic regression modeling for the combination of stage 2 or 3 AKI after surgery demonstrated that the last preoperative creatinine (for each 1 mg/dl increase, odds ratio = 3.23, 95% CI 1.83 to 5.69; p <0.001) and dye load (for each 10 ml increase, odds ratio = 1.04, 95% CI 1.01 to 1.08; p = 0.006) were significant predictors for AKI. In conclusion, AKI after TAVR is associated with increased postoperative and 3-year mortality. Significant multivariate predictors are potentially modifiable before the procedure.
authors.affiliation: Departments of Cardiology and Cardiovascular Surgery, The Heart Hospital, Baylor, Plano, Texas; Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors.forename: Mani
authors.initials: M
authors.lastname: Arsalan
authors.affiliation: Departments of Cardiology and Cardiovascular Surgery, The Heart Hospital, Baylor, Plano, Texas.
authors.forename: John J
authors.initials: JJ
authors.lastname: Squiers
authors.affiliation: Department of Research, Medical City Hospital, Dallas, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: Farkas
authors.affiliation: Department of Research, Baylor Research Institute, Dallas, Texas.
authors.forename: Christina
authors.initials: C
authors.lastname: Worley
authors.affiliation: Department of Research, Medical City Hospital, Dallas, Texas.
authors.forename: Morley
authors.initials: M
authors.lastname: Herbert
authors.affiliation: Department of Research, Baylor Research Institute, Dallas, Texas.
authors.forename: Wells
authors.initials: W
authors.lastname: Stewart
authors.affiliation: Departments of Cardiology and Cardiovascular Surgery, The Heart Hospital, Baylor, Plano, Texas.
authors.forename: William T
authors.initials: WT
authors.lastname: Brinkman
authors.affiliation: Department of Research, Baylor Research Institute, Dallas, Texas.
authors.forename: Ethan
authors.initials: E
authors.lastname: Ungchusri
authors.affiliation: Departments of Cardiology and Cardiovascular Surgery, The Heart Hospital, Baylor, Plano, Texas.
authors.forename: David L
authors.initials: DL
authors.lastname: Brown
authors.affiliation: Departments of Cardiology and Cardiovascular Surgery, The Heart Hospital, Baylor, Plano, Texas.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: Departments of Cardiology and Cardiovascular Surgery, The Heart Hospital, Baylor, Plano, Texas; Department of Research, Baylor Research Institute, Dallas, Texas. Electronic address: eholper@gmail.com.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holper
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*