title: Transapical versus transfemoral approach and risk of acute kidney injury following transcatheter aortic valve replacement: a propensity-adjusted analysis.
abstract: BACKGROUND
  The aim of this study was to compare the incidence of post-procedural acute kidney injury (AKI) and other renal outcomes in patients undergoing transapical (TA) and transfemoral (TF) approaches for transcatheter aortic valve replacement (TAVR).
  
  
  METHODS
  All consecutive adult patients undergoing TAVR for aortic stenosis from 1 January 2008 to 30 June 2014 at a tertiary referral hospital were included. AKI was defined based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression adjustment, propensity score stratification, and propensity matching were performed to assess the independent association between procedural approach and AKI.
  
  
  RESULTS
  Of 366 included patients, 171 (47%) underwent TAVR via a TA approach. AKI occurrence in this group was significantly higher compared to the TF group (38% vs. 18%, p < .01). The TA approach remained significantly associated with increased risk of AKI after logistic regression (OR 3.20; CI 1.68-4.36) and propensity score adjustment: OR 2.83 (CI 1.66-4.80) for stratification and 3.82 (CI 2.04-7.44) for matching. Nonetheless, there was no statistically significant difference among the TA and TF groups with respect to major adverse kidney events (MAKE) or estimated glomerular filtration rate (eGFR) at six months post-procedure.
  
  
  CONCLUSIONS
  In a cohort of patients undergoing TAVR for aortic stenosis, a TA approach significantly increases the AKI risk compared with a TF approach. However, the TAVR approach did not affect severe renal outcomes or long-term renal function.
authors: a Department of Internal Medicine, Division of Nephrology and Hypertension , Mayo Clinic , Rochester , MN , USA.
authors: Charat
authors: C
authors: Thongprayoon
authors: a Department of Internal Medicine, Division of Nephrology and Hypertension , Mayo Clinic , Rochester , MN , USA.
authors: Wisit
authors: W
authors: Cheungpasitporn
authors: b Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine , Mayo Clinic , Rochester , MN , USA.
authors: Narat
authors: N
authors: Srivali
authors: c Medical Scientist Training Program , Mayo Clinic , Rochester , MN , USA.
authors: Andrew M
authors: AM
authors: Harrison
authors: a Department of Internal Medicine, Division of Nephrology and Hypertension , Mayo Clinic , Rochester , MN , USA.
authors: Wonngarm
authors: W
authors: Kittanamongkolchai
authors: d Department of Surgery, Division of Cardiovascular Surgery , Mayo Clinic , Rochester , MN , USA.
authors: Kevin L
authors: KL
authors: Greason
authors: a Department of Internal Medicine, Division of Nephrology and Hypertension , Mayo Clinic , Rochester , MN , USA.|b Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine , Mayo Clinic , Rochester , MN , USA.
authors: Kianoush B
authors: KB
authors: Kashani
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D062606:Tertiary Care Centers; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome
keywords: AKI; Acute kidney injury; TAVR; approach; transapical; transcatheter aortic valve replacement; transfemoral