Acute kidney injury after transcatheter aortic valve implantation with self-expanding CoreValve prosthesis: Results from a large multicentre Italian research project

Marco Barbanti, Azeem Latib, Carmelo Sgroi, Claudia Fiorina, Marco De Carlo, Francesco Bedogni, Federico De Marco, Federica Ettori, Anna Sonia Petronio, Antonio Colombo, Luca Testa, Silvio Klugmann, Arnaldo Poli, Diego Maffeo, Francesco Maisano, Patrizia Aruta, Simona Gulino, Alessandra Giarratana, Martina Patané, Stefano CannataSebastiano Immé, Lorenza Mangoni, Agnese Rossi, Corrado Tamburino

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: 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. Methods and 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.

Original languageEnglish
Pages (from-to)133-140
Number of pages8
JournalEuroIntervention
Volume10
Issue number1
DOIs
Publication statusPublished - 2014

Keywords

  • Aortostenosis
  • TAVI
  • Valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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