title: Acute Kidney Injury After Transcatheter Aortic Valve Replacement.
abstract: BACKGROUND
  Acute kidney injury (AKI) during transcatheter aortic valve replacement (TAVR) increases morbidity and mortality. In this study, we investigated the incidence and risk factors for AKI in patients undergoing TAVR.
  
  
  METHODS
  Two hundred ninety consecutive patients underwent TAVR. Valve Academic Research Consortium (VARC)-I criteria for AKI diagnosis at 72 hours, and VARC-II criteria at seven days were employed.
  
  
  RESULTS
  Overall AKI incidence was 24.62% (65/264): 50 patients at 72 hours and 15 patients at seven days. Multivariate logistic regression determined transapical (TA) approach (OR: 4.46 [1.37-7.63]), preprocedural glomerular filtration rate less than 45 mL/min (OR: 3.47 [1.35-14.70]), and blood transfusion (OR: 3.34 [1.58-11.09]) as independent predictors for AKI at 72 hours; and prior coronary artery bypass grafting (OR: 3.02 [1.007-9.09]) and peripheral artery disease (PAD) (OR: 3.53 [1.06-11.62]) for AKI at seven days. In-hospital and 30-day mortality was higher in AKI patients. Non-AKI patients' survival was 93% at six months, 89% at 12 months, and 86% at 24 months, whereas survival in AKI at 72 hours was 66% at 6, 12, and 24 months (HR AKI vs. non-AKI: 3.9 [CI: 2.0-7.6]), and survival in AKI at seven days was 64% at 6, 12, and 24 months, HR: 3.13 (CI: 1.42-6.92). For the 12 dialysis patients survival was 82% at 6, 12, and 24 months.
  
  
  CONCLUSIONS
  AKI after TAVR is associated with worse outcomes. Blood transfusion should be administered restrictively in TAVR. Patients with CKD, PAD, prior CABG, and TA approach require close surveillance as they are at risk for AKI through seven days after TAVR. doi: 10.1111/jocs.12768 (J Card Surg 2016;31:416-422).
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Seyed Hossein
authors.initials: SH
authors.lastname: Aalaei-Andabili
authors.affiliation: Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Negiin
authors.initials: N
authors.lastname: Pourafshar
authors.affiliation: Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Bavry
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Charles T
authors.initials: CT
authors.lastname: Klodell
authors.affiliation: Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: R David
authors.initials: RD
authors.lastname: Anderson
authors.affiliation: Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Karimi
authors.affiliation: Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: John W
authors.initials: JW
authors.lastname: Petersen
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Beaver
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D058729:Peripheral Arterial Disease; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D051436:Renal Insufficiency, Chronic; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement